Potential role of hybrid positron emission tomography in pre-operative assessment of primary salivary gland carcinomas.

OBJECTIVE: The added value of hybrid positron emission tomography is increasingly recognised in head and neck cancer. However, its potential role in salivary gland carcinomas has been scarcely investigated. METHODS: A consecutive cohort of 45 salivary gland carcinoma patients who underwent pre-therapeutic hybrid positron emission tomography and surgical resection was reviewed. This study investigated whether maximum standardised uptake value correlated with tumour phenotype. RESULTS: Tumours of high-grade disease on histology (salivary duct carcinoma, carcinoma ex pleomorphic adenoma) had higher maximum standardised uptake value (Kruskal-Wallis test, p = 0.011) than low-grade tumours (adenoid cystic carcinoma and acinic cell carcinoma). Patients with pathologically confirmed node-positive disease had significantly higher maximum standardised uptake value of the primary tumour than patients with pathologically confirmed node-negative disease (Kruskal-Wallis test, p = 0.012). CONCLUSION: Maximum standardised uptake value of the primary tumour may guide clinical decision-making in patients with salivary gland carcinomas, as a high maximum standardised uptake value is associated with high-grade tumour histology and the presence of lymph node metastases. Clinicians may consider more aggressive surgery for these patients.

[Purulent lymphadenitis after peritonsillar abscess under immunosuppression. An often forgotten differential diagnosis]. / Eitrige Lymphadenitis nach Abszesstonsillektomie bei Immunsuppression. Eine oft vergessene Differenzialdiagnose.

In the present case study, a 75-year-old, immunosuppressed man presented with recurrent cervical abscesses after a peritonsillar abscess. In the cervical region, an ulcer developed with persistent wound healing deficit. Subsequently, the patient's general condition deteriorated, showing symptoms of a Landouzy sepsis. In the course of the examination, Mycobacteria tuberculosis was detected in the cervical ulcer. He suffered from latent tuberculosis, which was reactivated by a combination of his disease, immunosuppressive therapy and the preceding peritonsillar abscess. Upon treatment with tuberculostatics, the patient fully recovered.

Relevance of sentinel node procedures in head and neck squamous cell carcinoma.

The management of the clinically and radiologically negative neck (cN0) in patients with early oral and oropharyngeal squamous cell carcinoma (OSCC) is still a matter of debate, though most centers favor an active policy and perform END for staging of the neck and removal of occult disease. In the past decade SNB has been successfully implemented in early stage head and neck carcinomas. A large number of validation studies have shown an excellent safety profile with good sensitivity for the identification of occult neck metastases. The status of the neck is more accurately assessed by step-serial sectioning (SSS) and immunhistochemistry (IHC) of the sentinel lymph nodes (SN) compared to routine histopathologic work up of a comprehensive lymph node dissection specimen. Gain in experience as well as technical developments have lead to a wider use of SNB even in the complex lymphatic system of the Head and Neck region. First observational trials have documented its oncological accuracy and safety with success rates in controlling the neck comparable to END. The role of small tumor deposits only detectable by the extensive histopathologic work-up of the SNB-protocol is controversial. The overview comprises an introduction of the sentinel node procedure and indications in the head and neck region. The methodology as well as the histological work up and reporting of SNB is described. Finally, the clinical application, prognostic significance and future perspectives of SNB are summarized.

Isolated fungus ball mimicking mucocele or frontal sinus tumour: a diagnostic pitfall.

OBJECTIVE: To demonstrate the clinical, radiological and diagnostic pitfalls of managing an isolated frontal sinus fungus ball, and to compare with the literature. MATERIAL AND METHODS: Retrospective analysis of two cases and literature review. RESULTS: Isolated frontal sinus fungus ball is a rare cause of frontal sinus disease. We present two cases of isolated frontal sinus fungus ball which pre-operatively were suspected to be either a tumour or a mucocele. In both cases, cheesy, clay-like material was found intra-operatively within the frontal sinus, suggesting a fungus ball. Effective treatment included surgical debridement via an exclusively endoscopic or an external approach, variously. Final histopathological and mycological analysis revealed Aspergillus fumigatus. A literature review revealed 20 reported cases of isolated frontal sinus fungus ball, confirming the low prevalence of the disease. CONCLUSIONS: Frontal sinus fungus ball should be considered in the differential diagnosis of chronic, nonspecific forehead symptoms. To evaluate the underlying disease, computed tomography scans should first be performed, followed by magnetic resonance imaging if malignancy is suspected. It is essential to be aware of the possibility of an atypical fungus ball appearance on computed tomography and magnetic resonance imaging scans. If bony destruction and calcification coexist on radiological images, then endoscopic biopsy is an indispensable part of the diagnostic procedure, and should be performed to collect material for both histological and mycological analysis, and to aid surgical planning. In cases of sinus fungus ball, an endoscopic approach for biopsy may be curative.

How to diagnose sinus fungus balls in the paranasal sinus? An analysis of an institution's cases from January 1999 to December 2006.

BACKGROUND: The diagnosis of a sinus fungus ball (SFB) is often not clear despite well-defined diagnostic criteria. OBJECTIVE: To study the radiological, intraoperative and histological diagnostic accuracy in comparison to results from mycological and histological analysis. METHODS: Systematic review of 724 files from patients treated for chronic rhinosinusitis from 1999 - 2006 at our institution. RESULTS: The sensitivity, specificity, positive and negative predictive value (PPV, NPV) of pre- operative CT imaging was 83%, 94%, 56% and 98% respectively, whereas, based on intra- operative findings, it was 98%, 93%, 57% and 100%. CONCLUSIONS: A high number of misdiagnoses was found possibly due to sampling error. A severe inflammatory reaction of the surrounding tissue was found more often in SFB than in controls in our study and this we suggest could be an additional sign for fungal infection. Fungal cultures did not contribute to a correct diagnosis.

[Illegal professional conflict of interest from the viewpoint of the attorney]. / Unerlaubte Zuwendungen aus Sicht des Rechtsanwaltes.

Since the so called "heart-valve scandal" occurred in Germany, the practice of financially or otherwise supported hospitals and practicing doctors has to be critically re-examined and may be changed. The practice and acceptance of support is common in many areas of our daily life, however, due to governmental social laws regulating the flow of money and due to the various financial forms of support for the health care system, criminal violations and sanctions may arise. Aside from the existing standard criminal violations, a new law, as of has been enacted August 13, 1997-this law specifically deals with bribery and the acceptance of such illegal payments. Proving that such a criminal violation was committed by a physician can be very difficult for the prosecutor. The mass of procedural laws--aside from the substantive law requirements--cause problems for the state. It is also very difficult to determine the exact amount of damages or that a physician has gained an illegal advantage. In these specific and other general cases, a professional defense by a competent attorney is absolutely essential to prevent an unpleasant suit or to resolve charges outside of court. In some cases, it may even be possible to persuade the prosecutor to only levy a fine, if it is not possible to persuade him to drop the charges all together--for lack of good evidence.

[The physician between cost control and quality requirements]. / Arzt zwischen Wirtschaftlichkeitsgebot und Sorgfaltspflicht.

In times of reduced monetary resources of the current German health system, it is more and more difficult for the German physicians to comply with the high medicinal care standard and to practice economically. Nevertheless, the economical reasons cannot deny the high medical quality standards. Regarding the principle of the unity of jurisdiction, the validity of the social welfare law, that a performance has to be "just sufficient and suitable", must concur with the demand of liability law of "indication of the medical service". The economical duties reach their limit when they increase the risk for the patient. On the other hand, the economy interests have to be regarded by the "principle of the allowed risk". Therefore, it should be considered that in every single case the severity and probability of the risk has to be weighed against the cost aspect.