3D power Doppler analysis of the vascularisation in tumours of the oral cavity.

PURPOSE: The aim of this study was to determine the volume and vascularisation of tumours by three-dimensional (3D) power Doppler ultrasound in patients with "tumours of the oral cavity". MATERIALS AND METHODS: Three-dimensional (3D) power Doppler ultrasound investigation was performed pre-operatively on 49 patients with carcinomas of the oral cavity. Digitally-stored data were analysed with 3D View program software, a part of which is the "VOCAL-Imaging program". By using VOCAL, the borders of a structure (tumour) can be determined and its volume calculated. The vascularisation of the tumour was determined by analysing three-dimensional colour histograms, and the vascularisation indices were calculated. RESULTS: Vascularisation indices VI and VFI were significantly higher in patients with neck metastases. The differences between the vascularisation indices in N+ and N0 necks were statistically significant (p < 0.05). The flow index (FI) values between N+ and N0 necks were not statistically different. CONCLUSION: The volume and vascularisation of tumours of the oral cavity could be determined effectively by three-dimensional power Doppler ultrasound. Tumour vascularisation is higher in metastatic than in non-metastatic tumours.

Inflammatory reaction to foreign body (amalgam) in the maxillary sinus misdiagnosed as an ethmoid tumor.

A patient with chronic unilateral maxillary sinusitis caused by a foreign body (dental amalgam) and mistaken diagnosis of extensive ethmoid neoplasm is presented. The imitation of tumour symptoms was due to a long presence of foreign body in the maxillary sinus and chronic inflammation of maxillary, ethmoid and sphenoid sinuses.

The stable gastric pentadecapeptide BPC 157, given locally, improves CO2 laser healing in mice.

The stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV; mol. wt. 1419), which is at present in phase II clinical trials for the treatment of inflammatory bowel disease, has been shown to counteract healing impairment by systemic corticosteroids in burned mice, both in vivo and in vitro, in the absence of carrier or protease inhibitor. Because of the particular healing problems associated with laser use, we have now studied the effect of pentadecapeptide BPC 157 on CO(2) laser injuries (Sharplan 1075 laser: 20 W, distance 12.5 cm, spot size 0.8 mm and exposure time 1s) created on the dorsal skin of anaesthetised male NMRI-Hannover mice. The injury was either not treated or treated by topical application of a thin layer of neutral cream containing pentadecapeptide BPC 157 (1 microg, 1 ng or 1 pg (dissolved in saline)/g) or vehicle only, once daily, with the first application 60 min after injury and the last 24 h before killing (1, 7 and 21 days after the laser application). BPC 157 consistently improved healing after the CO(2) laser injury, both macroscopically and microscopically. The effect was produced with a simple method of application and favourable peptide stability (no carrier), and confirms the effectiveness of an ointment containing 1 microg BPC 157 (dissolved in saline)/g neutral cream.

[A bronchial polyp and foreign body in an adolescent]. / Polip i strano tijelo bronha u adolescenta.

A fifteen-year-old adolescent with recurrent pneumonia in the last two years is presented. The polyp in the lobar bronchus for the right inferior lobe and a foreign body in posterobasal segmental bronchus were found on bronchoscopy. The polyp (patHohistologically confirmed granulomatous tissue) and foreign body (thorny fruit of small caltrops, Tribulus terrestris) were extracted through a rigid ventilatory bronchoscope. The polyp presumably developed from the thorn of the fruit stuck in bronchial mucosa.

Intraoral sonographic evaluation of parapharyngeal space tumors.

We performed transcutaneous (external) sonography and then intraoral sonography to evaluate 3 parapharyngeal space tumors (1 vagal paraganglioma, 1 pleomorphic adenoma, and 1 carcinoma arising in a pleomorphic adenoma). All 3 patients had medial displacement of a tonsil. In all cases, we could measure the size and see the borders of the tumors and their relation to other structures on intraoral sonography. Intraoral sonography is useful for differentiating between unilaterally enlarged and medially displaced tonsils.

Inflammatory pseudotumor of the trachea.

Primary tracheal tumors are extremely rare, and the majority of them are malignant. Inflammatory pseudotumor is a benign, tumorlike lesion, most likely of a reactive nature. Its basic morphologic characteristic is spindle cell (myoblasts and fibroblasts) proliferation with a variable number and type of inflammatory cells. A case of intratracheal inflammatory pseudotumor in a 14-year-old boy is presented together with a review of all similar lesions in the available literature. The discussion includes the presentation of tracheal tumors, their basic morphologic and immunohistochemical characteristics, and treatment modalities that are available. The surgeon must exercise caution not to perform radical surgery based on the initial pathologic diagnosis from the intraoperative frozen section, because the prognosis of these benign lesions generally is excellent. This is the second reported case of intratracheal inflammatory pseudotumor successfully endoscopically vaporized using a CO(2) laser, which is an excellent alternative in cases in which surgical treatment is feasible. J Pediatr Surg 36:631-634.

Congenital oral gastrointestinal cyst: an immunohistochemical analysis.

Cystic lesions of the oral cavity are quite common. Mostly their morphology is that of simple cystic lesions lined by squamous epithelium. Rarely the epithelium may be of another type, e.g. that of gastrointestinal tract. In the English literature in English about 30 cases of oral cysts with gastrointestinal epithelium lining have been reported. This developmental lesion is very rare and is found more frequently in young males. The majority of lesions were reported to occur in the ventral surface of the anterior tongue and extend to the floor of the mouth. Heterotopic gastrointestinal epithelium has been more commonly described in the duodenum, gallbladder, jejunum, Meckel's diverticulum, ileum, appendix, colon and rectum. We report an oral heterotopic gastrointestinal cyst in a child. A healthy 2-month-old boy had an asymptomatic swelling in the sublingual area that had been present since birth. Under general anesthesia, the patient underwent conservative excision of the cyst. Gross examination of the excised tissue showed a monolocular cystic lesion in the bottom of the oral cavity. Microscopically, the cystic lining mostly resembled intestinal mucosa; in some places, stratified squamous and columnar epithelium was also present. The pathogenesis of this lesion remains uncertain. Several theories have been postulated; the most commonly held suggests that these cysts may be derived from misplacement of embryonic rests.

Lingual thyroid.

Lingual thyroid is one of the rarest anomalies of thyroid origin. It is located in the midline of the base of the tongue. Lingual thyroid répresents ectopic, i.e. accessory thyroid tissue. It develops from the epithelium of the thyroglossal duct that has not obliterated properly, and it is sometimes the only thyroid tissue. Beside two cases presented, the embryology, symptomatology, diagnostic and therapeutic procedures, the literature reports of lingual thyroid are reviewed.

[Reconstruction of the cervical esophagus with free autotransplantation of the jejunum--direct monitoring of viability]. / Rekonstrukcija vratnog jednjaka slobodnim autotransplantatom jejunuma--izravno pracenje vitalnosti.

Although free jejunum transfer has become an accepted form of hypopharyngeal reconstruction, an ideal method of monitoring the viability of the graft has not been devised yet. The method of direct visualisation through the incision in the skin above the transferred jejunum has proven very reliable and easy to perform, especially for the nursing staff. This reliable method of monitoring free vascularised jejunum to the neck region has been used in two patients. After two days of direct monitoring, the incision in the skin healed without additional sutures. No failures of the graft occurred, and 12 days later the patients were able to swallow fluids without difficulty. The effectiveness of this technique has surpassed that of all previously published methods.

Fibrous dysplasia in paranasal cavities.

Presentation is made of 2 boys and a girl with fibrous dysplasia involving the frontal and ethmoidal sinuses and the maxilla. This tumor-like growth of the bone was not restricted to the sinus alone but expanded to the orbit, adjacent sinus, skull base and infratemporal or pterygoid fossa. In such cases, surgical therapy is the treatment of choice, with maximal preservation of healthy tissue and avoidance of major devastations that may result in undesired cosmetic defects. The etiology of the disease is still unknown. However, it should be emphasized that all 3 patients had suffered an injury to the adjacent bony structures at various time points preceding the disease manifestation. That is why we are inclined to believe that trauma might be a factor responsible for the onset of fibrous dysplasia.

[Morphometric evaluation of connective tissue reaction to cartilage implants]. / Morphometrische Bewertung der Bindegewebsreaktion auf Knorpelimplantate.

In this paper, besides already investigated cartilage implants, we studied morphologically and histometrically possibilities to use human thyroid cartilage in reconstructive surgery, especially in nasal septum and pyramid reconstructions. Preserved human thyroid and rib cartilage as well as rabbit preserved rib cartilage were implanted under the back skin of 12 New Zealand rabbits. Animals were divided into two groups with 6 specimens in each group followed 6 and 12 weeks after implantation. Beside morphological investigation we measured histometrically the thickness of connective capsule around implants. Results obtained by our morphological and histometric studies indicate that preserved human thyroid cartilage could be used in reconstructive surgery with the same success as other cartilage implants already used.

[Video fluoroscopy of the swallowing act following partial supraglottic laryngectomy]. / Videofluoroskopie des Schluckaktes nach partieller supraglottischer Laryngektomie.

Videofluoroscopy of swallowing was performed in 21 patients who had undergone partial horizontal laryngectomy. Food residues were present in most of these patients. Residues of liquid contrast were observed in 85.7% of the patients and residues of consistent contrast in 61.5% of the patients. In most cases, food remnants were to be found in the glossolaryngeal recess. The mechanisms of compensation, additional swallowing, and expiration after swallowing are an important factor in clearing the throat of any residual food. Impaired clearing of food residues results in aspiration. Aspiration of liquid contrast was observed in 76.2% of the patients and aspiration of consistent contrast in 19.1% of the patients (p less than 0.001). Aspiration after swallowing was observed in most of the patients.

Cytostatic and immunologic treatment of head and neck tumors.

Advanced head and neck tumors have a very low survival rate when treated by classical methods of irradiation and surgery. This is why in the last ten years cytostatics and immunotherapy have been applied. Clinical experience speaks in favour of polychemotherapy in comparison to monochemotherapy. In head and neck tumors bleomycin, methotrexate, 5-fluorouracil, vincristine and cis-Platinum have been used most often. They can be applied as initial therapy, additional therapy after surgery and irradiation, and finally as palliative therapy. Present experiences have shown the best results with initial therapy in 2-3 cycles, before surgery and irradiation. Toxicity of cytostatics depends on the dose and the sensitivity of the patient. The interval between cycles is 2-3 weeks. According to clinical experience, active specific immunotherapy with tumor vaccine did not prove successful. The investigations have thus been directed towards the means which would mobilise the immunological forces of the organism and remove obstacles in reaction of cytotoxic drugs and tumor cells. Such biological response modifiers are interferon, hormone of the thymus, substances which increase, change or restore immunological reactivity, lymphocytes, tumor preventive agents, NK cells, lymphokines, monokines and allokines, plasmophoresis and indomethacin.

[Coordinating breathing and swallowing following laryngectomy]. / Atmung und Schluckkoordinierung nach Laryngektomie.

Integrated study of respiration and deglutition includes 48 healthy examinees and 22 patients after laryngectomy. Laryngectomy changes the relationship between breathing and swallowing. In healthy subjects 70.68 per cent of swallows occurs during the expiratory phase and more than 80 per cent are followed by expiration. In the patients after laryngectomy 58.01 per cent of swallows coincide with the end of the expiration end the beginning of the inspiration and near 80 per cent of swallows are followed by inspiration. Laryngectomy eliminates necessity for specific coordination of breathing and swallowing and makes possible manifestation of the central neural control.

[Mechanisms of adaptation of breathing and swallowing coordination following partial laryngectomy]. / Adaptationsmechanismen der Atmung und Schluckkoordinierung nach partieller Laryngektomie.

Integrated study of respiration and deglutition includes 48 healthy examinees and 30 patients after partial laryngectomy. Every act of swallowing is accompanied by a respiratory pause (swallow apnoea) which in healthy subjects lasts for approximately 0.7438 sec. In the patients after partial laryngectomy swallow apnoeas are significantly prolonged and last for approximately 1.2482 sec. Swallow apnoea is usually followed by expiration. This is observed in the majority of subjects, its function being the protection of the lower respiratory pathways. Besides the interaction between breathing and swallowing, synergism is also present, functioning as adaptive mechanism of the upper respiratory and gastrointestinal system.