[Infectious mononucleosis]. / Die infektiöse Mononukleose.

The primary infection with Epstein-Barr virus in an immunocompetent individual leads to infectious mononucleosis with symptoms of diphtheroid angina, lymph node swelling in the neck and hepatosplenomegaly. The most common age of infection lies between 15 and 25 years. The illness can affect a number of organs simultaneously and thus requires interdisciplinary diagnostics. For differential diagnosis, a differential blood analysis and a EBV quick test are required. The presence of IgM antibodies demonstrates the presence of the infection. Ultrasound of the abdomen can be made to determine the involvement of additional organs. In most cases, recovery occurs without complications. Acute cases can usually be handled successfully with medication. If symptomatic treatment fails, pharyngeal airway obstruction is possible and a tonsillectomy may be necessary. Otherwise, surgical treatment is obsolete. Generally, the prognosis is good. Severe courses and complications are rare.

[Thermal irritation of the organ of equilibrium by means of heat radiation (NIR)]. / Thermische Reizung des Gleichgewichtsorganes mittels Wärmestrahlung (NIR).

BACKGROUND AND OBJECTIVE: Convection and conduction are the main factors involved in caloric response. Heat radiation has also been discussed as an important factor. The present work tests whether heat radiation is an essential part of the caloric response and whether caloric irritation of the semicircular canals is possible using two sources with a different near infrared (NIR) spectrum. In addition, we tested whether it is possible to induce a detectable nystagmus reaction using either NIR-radiation sources. RESULTS: NIR is able to penetrate bone tissue. The temperature elevation in dry and wet bones was almost immediately registered. With high optical power, specific temperature maxima could be seen by focal and selective broad spectrum and monochromatic NIR irritation of the three semicircular canals. Nystagmus could be generated after using both NIR emission sources in five probands. CONCLUSIONS: NIR generates temperature differences and nystagmus. By using a broad scale as well as a monochromatic NIR-emission source, it is possible to generate a nystagmus. The procedure of NIR-irritation occurs without physical contact, is painless and quiet.

[Selective stimulation of the equilibrium organ using monochromatic near infrared]. / Gezielte Strahlungskalorisation des Gleichgewichtsorgans mit Nahinfrarot.

BACKGROUND: The aim of this study was, to establish, if a selective thermal warm-stimulation using monochromatic near infrared radiation (NIR) in healthy persons, patients with chronic otitis media (chronic mucosal inflammation) and after radical surgery of one ear shows quantitative or qualitative changes of the nystagmus reaction. PATIENTS AND METHODS: Healthy persons (n = 3), patients with a large central defect of the tympanic membrane (n = 5) and after radical ear surgery (n = 6) were examined. In healthy persons a stimulation with monochromatic NIR (lambda = 980 nm) of several areals of the external auditory canal was performed. In patients with large defects of the tympanic membrane the promontorium was stimulated. In patients with a radical cave of the ear a selective NIR-stimulation of the region of the vertical and the anterior semicircular canal was performed. The horizontal semicircular canal was visible as a landmark. Registration of the nystagmus was performed by means of videonystagmography. RESULTS: In healthy persons the mean slow phase velocity of the nystagmus depended on the stimulated region. But there was no qualitative change of three dimensional eye movement. Stimulation of the promontorium showed a strong directional horizontal nystagmus. In patients with a radical cave the stimulation of the regions of the three semicircular canals showed a qualitative difference in three dimensional eye movement. NIR-stimulation showed in all cases a nystagmus into the stimulated ear. CONCLUSIONS: The method of monochromatic near infrared stimulation can be used for selective stimulation of several regions of the external auditory canal, the promontorium and the regions of the semicircular canals in a radical cave of the ear as well as to prove the warm reaction of the equilibrium organ. A specific nystagmus after stimulation of the semicircular canal-region in a radical cave of the ear could be an indication for a normal semicircular canal function.

[Near infrared stimulation of the equilibrium organ--first clinical experiences]. / Nahinfrarotreizung des Gleichgewichtsorgans--erste klinische Erfahrungen.

BACKGROUND: A new method for the stimulation of the organ of equilibrium by means of a broad-scale and monochromatic near infrared emission was developed. This method should be examined within the framework of a pilot study, evaluated and its clinical possible applications examined. PATIENTS AND METHODS: Healthy probands (n = 15), patients with a radical cave of the ear (n = 5), patients with a defect of the tympanic membrane (n = 5) and spontaneous nystagmus (n = 5) were examined. In healthy probands an irritation with broad-scale as well as monochromatic near infrared (NIR) was performed and compared with a water irrigation (44 degrees, 50 ml in 30 seconds). The subjective, local feelings during the application and the appearance of giddiness according to irritation were recorded and the nystagmus was registered by means of videonystagmography. In patients with radical cave of the ear and tympanic membrane defects, a broad-scale NIR-irritation before a comparative irritation with warm air (44 degrees) was performed exclusively. RESULTS: In all healthy probands, a nystagmus reaction could be seen with broad-scale and monochromatic NIR. Compared to the hot water irritation slow phase velocity (SPV) was decreased however registrable by means of Frenzel glasses and electronystagmography during the culmination stage. In patients with radical cave (n = 4) and tympanic membrane defects (n = 3) showing paradoxical nystagmus reaction during hot air irritation, a nystagmus to the site of stimulation resulted by means of light calorisation. In patients with a spontaneous nystagmus an attenuation (n = 1) or inversion (n = 2) could be achieved by NIR-radiation. CONCLUSIONS: The method of the NIR-radiation is suitable in clinical practice for the caloric test proofing warm reaction. Vaporization cold does not occur. The application of heat charm is better proportionable and steerable than during air irritation. The procedure is sterile, noiseless and non-contact. Difficulties in interpretation of results of vestibular tests because of evaporation coldness do not occur.

[Lyme disease--a reason for sudden sensorineural hearing loss and vestibular neuronitis?]. / Die Lyme-Borreliose--eine Ursache für "Hörsturz" und "Vestibularisausfall"?

BACKGROUND: Lyme disease has been described as one possible cause of sudden sensorineural hearing loss and vestibular neuronitis. The necessity of serological diagnosis and its therapeutic consequences have been discussed controversially. PATIENTS AND METHODS: 344 patients with acute sensorineural hearing loss and 66 patients with vestibular neuronitis were examined in retrospect. By means of ELISA (Enzygnost Borreliosis, Dade Behring Marburg) the specific prevalences of IgG- and IgM-antibodies against borrelia in serum were evaluated. The frequency of seroprevalences for both diseases were compared to those given in the literature. Neurootological findings of the seropositive patients were compared with those of seronegative and analysed statistically. RESULTS: 15.7 % of the patients with sudden sensorineural hearing loss had positive levels of IgG-antibodies. IgM-titers were elevated in 4.7 % of the patients. The seroprevalences for IgM and IgG were above those described by other investigators for the healthy population. Patients with positive IgM-antibodies showed more often low frequency hearing loss than IgG-positive patients. 18.2 % of the patients with neuronitis vestibularis had IgG- and 1.5 % IgM-antibodies against Borrelia. Whereas IgG occurred more often than known for the healthy population, IgM was within the limit for the healthy population. The seropositive group did not show any remarkable neurootological signs compared with the seronegative group. CONCLUSIONS: Because of the elevated seroprevalences Borrelia infections may be one possible but very rare cause of sudden sensorineural hearing loss and vestibular neuronitis. Low frequency hearing loss may be a sign for an infection with Borrelia as an etiological factor especially in combination with seropositive titers. In case of the presence of IgM-antibodies, patients may be treated with oral antibiotics (Doxycyclin, Cefuroxim). In patients with neuronitis vestibularis a neuroborreliosis should be excluded by means of lumbar puncture.

[The influence of bioceramics on phagocytosis of human leukocytes]. / Untersuchungen zum Einfluss von Biokeramiken auf die Phagozytoserate humaner Leukozyten.

BACKGROUND: After implantation of biomaterials in the regions of head and neck with resident microbial contamination the interaction between the implant and microbes play an important role for the success of the implantation. The host immune defence is important for the outcome after implantation, too. Phagocytosis plays an important role in the human immune response on infections. MATERIAL AND METHODS: The method described by Suess was used to investigate and measure the influence of the bioceramics Bioverit((R)) and Al(2)O(3)-ceramic on phagocytosis of yeast by human leukocytes. RESULTS: The bioceramics showed no statistically significant influence on phagocytosis function by human leukocytes. There was a tendency towards lower phagocytosis rates in all samples with bioceramics. CONCLUSIONS: The bioceramics Bioverit((R)) and Al(2)O(3) ceramic have no influence on phagocytosis of human leukocytes. In conclusion these biomaterials did not cause any inhibition of this important part of the human immune response on microbial infections after alloplastic implantation in head and neck regions.

[Effect of bioceramics on biological activity of microorganisms]. / Untersuchungen zum Einfluss von Biokeramiken auf biologische Leistungen von Mikroorganismen.

BACKGROUND AND OBJECTIVE: Biomaterials that come into contact with microorganisms in the middle ear or paranasal sinuses should be tested before clinical application. Thus, it is necessary to test the influence exerted on bacterial growth by biomaterials used as bone substitutes in head and neck surgery before implantation. PATIENTS AND METHODS: In this study, Bioverit, Al2O3 ceramic, and glass carbon were subjected to contamination with typical microorganisms in the middle ear and paranasal sinuses such as Staphylococcus aureus, Streptococcus pneumoniae and salivarius, Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis and Candida albicans. RESULTS: In the suspension test, all gram-negative species were inhibited, but gram-positive microorganisms and Candida albicans were not affected. The Al2O3 ceramic showed the largest inhibition effect while growth inhibition of glass carbon was low. Streptococcus pneumoniae and salivarius can use glass carbon as a nutrient. In contrast, Bioverit and Al2O3 ceramic could not improve the growth of all tested microorganisms. CONCLUSIONS: In conclusion, we think that Bioverit is suitable for implantation in bacterially contaminated regions of the head and neck, whereas glass carbon is unsuitable for this application in reconstructive surgery.

[Degenerative changes in parapharyngeal schwannoma "ancient schwannoma". Case report and review of the literature]. / Degenerativ verändertes parapharyngeales Schwannom ,,ancient schwannoma". Fallbericht und Literaturübersicht.

Schwannomas are rare, slow-growing, benign neoplasms derived from the schwann cells of the nerve sheath of peripheral nerves. Extracranial schwannomas are most frequently localized within the extremities or the head and neck region. For example, they are common in the skull base, the carotid sheath, and the parapharyngeal space. Beneath several histological variants, schwannomas showing prominent degenerative changes (so-called,,ancient schwannomas") are exceedingly rare. Histopathological features, such as degenerative changes and nuclear atypias in ancient schwannomas, may be easily confused with malignant mesenchymal neoplasm.We present the case of a 32-year-old female who required surgery for a parapharyngeal neoplasm. Histological examination revealed features of an ancient schwannoma.

[Reactivation of telomerase in squamous epithelial carcinomas in the area of the head and neck]. / Reaktivierung der Telomerase in Plattenepithelkarzinomen des Kopf-Hals-Bereiches.

BACKGROUND: Head and neck cancer development involves the accumulation of multiple cellular alterations over a long period of time. Selection and expansion of altered cell clones can lead to the evolution of a malignant phenotype. The theory of carcinogenesis suggests that unlimited cell proliferation is required for development of malignant disease and cancer must attain immortality for progression to malignant states. One step in the immortalization process may be the reactivation of telomerase. This enzyme complex can prevent the continuous shortening of telomeres which is observed at each cell cycle. RESULTS: Telomerase activity was detected in 68% of squamous cell carcinomas of pharynx and larynx and 58% of histologically tumor-free resection margins. Recurrences occurred with a higher rate in cases with telomerase positive primary tumor. The importance of telomerase activity in histologically negative resection margins needs further investigations. Telomerase activity was found in 90% of corresponding lymph nodes without any correlation to metastasis in the lymph node. CONCLUSIONS: The reactivation of telomerase seems to be an important step in carcinogenesis of head and neck cancers. Further studies are necessary in order to understand the role of the enzyme as a possible marker for tumor progression and clinical outcome.

The basaloid squamous cell carcinoma of the nasopharynx.

The basaloid squamous cell carcinoma (BSCC) is a very rare and widely unknown malignant tumour of the upper aerodigestive tract. It is considered a particular variant of squamous cell carcinoma (SCC), but much more aggressive. A relatively little number of cases and clinical reports has been published since its first description in 1986 by Wain et al. Only five basaloid squamous cell carcinomas with location in the nasopharynx, where it seems to have a different biological behaviour, are mentioned in the international literature. We present a new case of BSCC with this location, referring to the pathologic and clinical aspects and to the respective literature.

Daily amifostine given concomitantly to chemoradiation in head and neck cancer. A pilot study.

BACKGROUND: In patients with loco-regionally advanced head and neck cancer conventionally fractionated radiotherapy alone results in poor loco-regional control and survival rates. Treatment intensification by simultaneous administration of cytotoxic drugs produces higher acute morbidity. Therefore chemical radioprotection of normal tissues may be of clinical benefit. PATIENTS AND METHODS: In a pilot study patients with advanced nonresectable head and neck cancer treated with conventionally fractionated radical radiotherapy (60 to 66 Gy total doses) and concomitantly given 5-fluorouracil as protracted venous infusion, 250 mg/sqm/24 h over the entire treatment period were given amifostine 300 mg absolutely before each fraction. Acute treatment related morbidity was scored according to CTC classification and loco-regional control and survival rates were estimated. Comparison was made with a historical control group of identical chemoradiation but without amifostine application. RESULTS: Chemoradiation induced oral mucositis was delayed and showed significant lower degrees at all 10 Gy increments (p < 0.05) except 60 Gy and over (p > 0.05). No significant toxicity was recorded with respect to blood pressure, serum calcium, potassium, hematologic parameters, emesis, nausea or body weight loss. Progression free survival and overall survival probability at 2 years were not statistically different in both cohorts. CONCLUSION: Amifostine given before each fraction of radiotherapy over 6 weeks has no cumulative toxicity, was well tolerated and may reduce treatment induced oral mucositis. No tumor protective effect was observed.

[Interval between initial symptoms and first treatment in patients with head-neck tumors]. / Untersuchungen zum Intervall zwischen Erstsymptom und Behandlungsbeginn bei Patienten mit Kopf-Hals-Tumoren.

We investigated the kinds of first symptoms and their delay in diagnosis by patients and physicians until the beginning of therapy in 92 patients with carcinomas of the head and neck. We were interested in the time from onset of first symptoms to the first consultation with a physician, the first contact with an ENT specialist and to admission to our hospital. We found no difference in the time of delay for first symptoms had by patients who consulted the family doctor first and those patients who were seen by an ENT specialist first. This may be due to almost all family doctors in Thuringia being specialists for general medicine. The patient was the decisive factor in delaying medical evaluation of first symptoms. Patients with laryngeal cancers had a twice as long interval between the first symptom and the initial consultation with a physician than patients with other cancers of the head and neck, since these latter tumors had clinically concerning symptoms in most cases. In patients with better education we found a longer interval between the onset of the first symptoms and the first consultation with a doctor. We think that better knowledge by patients about the first symptoms of a cancer of the head and neck and improved training in ENT diseases for specialists of general medicine will improve the overall rate for early detection of these tumors.

[Extracranial meningioma of the parotid gland]. / Extrakranielles Meningeom in der Glandula parotis.

Extracranial meningiomas of the head and neck region are very rare, although secondary extracranial meningiomas beside meningiomas of primary extracranial origin have also been described. Trauma, radiation and (uncommonly) metastatic spread have been associated with the pathogenesis of secondary extracranial meningiomas. We present a case of a 53-year-old patient who required six neurosurgical interventions because of a recurrent intracranial meningioma. Further surgery was required for tumor in the left parotid gland. Histological examination of this neoplasm showed an atypical meningotheliomatous meningioma. The patient is now 17 months after surgery and is free of local recurrences or metastases.

P53 genotyping - an effective concept for molecular testing of head and neck cancer?

P53 mutations are currently recognized as the most common genetic alteration in human tumors. The purpose of our study was to evaluate the significance and reliability of p53 genotyping in head and neck cancer as a possible marker permitting the prediction of tumor behavior and clinical outcome. P53 genotyping in our study refers to highly sensitive molecular screening in order to detect structural alterations in the nucleic acid sequence of the gene. Exons 2-11 and adjacent intronic regions were screened for mutations by direct genomic sequencing or by bi-directional dideoxyfingerprinting in 66 primary tumors of the larynx, pharynx and oral cavity. Alterations in the of the p53 gene were detected in 36% (24 of 66) of the analyzed tumors, no mutation was found in our cohort outside exons 5-8. The frequency of p53 mutation had no correlation to the tumor stage or tumor site. The recurrence rate in patients with a p53 alteration was not significantly higher compared to patients without a p53 mutation in their primary tumors. Summarizing the results of our study only limited reliability of p53 genotyping as an effective concept for molecular testing of head and neck cancer was found.

Tumor suppressor gene p16 (CDKN2A) mutation status and promoter inactivation in head and neck cancer.

The p16INK4A (CDKN2A/MTS1) putative tumor suppressor gene encodes a cyclin dependent kinase inhibitor which plays an important role in the regulation of the G1/S phase cell cycle checkpoint. A high frequency of various p16 gene alterations were consequently observed in many primary tumors. P16 can be inactivated by different mechanisms: i) homozygous deletion, ii) methylation of the promoter region or iii) point mutation. In order to investigate p16 alterations in head and neck cancer (HNC) we analyzed 70 primary tumors of the larynx, pharynx and oral cavity including their corresponding normal mucosa for mutation inactivation by direct sequencing exon 2. We detected only one so far undescribed transversion G to T at position 322 (Asp108Tyr) and a known polymorphism (Ala148Thr) in five cases. The methylation status of the p16 promoter region was analyzed by an improved highly sensitive methylation-specific PCR protocol. P16 methylation inactivation was found in 16 of 55 cases (29%). Our data indicate that p16 point mutations in HNC are less frequent, but inactivation by methylation of the promoter region could be involved in genesis and progression of HNC.

[The effect of biomaterials and other industrial materials on the growth of several aerobic bacterial species in vitro]. / Die Einwirkung von Biomaterialien und anderer Werkstoffe auf das Wachstum einiger aerober Bakterienspezies in vitro.

The article deals with interactions between bio-vitro-materials and bacteria species in vitro. The growth of S. aureus, Sc. salivarius, E. coli and Ps. aeruginosa in a salt solution with and without addition of biomaterials was examined until the day 60 in a static culture. By counting the cfu/ml and determination the relative change of germ capacity the results were compared. The data of such series obtained with working materials of similar chemical composition were collected and evaluated. We found, that Ps. aeruginosa was promoted in growth by all materials, especially those, which contained carbon. The same can be said about the last materials and E. coli. In contrast as well Ca- and P-containing as--free biomaterials reduced the numbers of germs. Changes of multiplying of S. aureus and Sc. salivarius seldom were observed. It ist apparent, that the biomaterials tested are not indifferent against a few germs, which may cause infections, but they promote the growth of a few species in vitro. This may favour an infection, if such materials should be implanted. It is proposed to test biomaterials microbiologically before clinical application. Materials with indifferent behavior or low anti-microbiological effect have to be favoured.

[Traumatic infraclinoid aneurysms]. / Zur Problematik traumatischer infraklinoidaler Aneurysmen.

Traumatic infraclinoidal aneurysms of the internal carotid artery are rare. They can occur after craniocerebral lesions and can lead to life-threatening haemorrhages from the nasopharyngeal space. Frequently it may take months after the accident before the patient experiences single or repeated rupture bleeding and is referred to acute treatment in an ENT ward. Angiography can confirm the diagnosis and is mandatory to clarify the question of collateral flow in cerebral circulation. In case of local inoperability combined with the need for a ligature of the internal carotid artery, the protective application of an extra-intracranial microvascular anastomosis is an improved safeguard against postoperative deficits. During the past five years five patients suffering from an infraclinoidal aneurysm of the carotid artery have been operated on successfully in this manner. Two of these patients suffered from a traumatic aneurysm; these two case reports are presented.