NUT Carcinoma of the Sublingual Gland.

NUT carcinoma (NC) is a recently described, rare and extremely aggressive cancer primarily located to supradiaphragmatic structures and affecting young individuals. NC is characterized by translocations involving the NUT gene on 15q14 with the most common translocation partner gene being BRD4 on 19p13, resulting in the t(15;19)(q14;p13) karyotype. NC is poorly differentiated and is likely to be overlooked and misdiagnosed as poorly differentiated squamous cell carcinoma (SCC) when immunohistochemical evaluation of NUT protein expression is omitted. Previously, NC has been found in the parotid and submandibular glands and we present the first case in the sublingual gland arising in a 40-year-old woman. We discuss the diagnostic considerations for poorly differentiated carcinomas of the salivary glands and advocate the inclusion of NUT immunohistochemistry in this setting. Not only does the NC diagnosis confer a grave prognosis when treated as SCC as illustrated by the present case, but is important for the inclusion of patients in ongoing clinical trials.

Residual tumour after vestibular schwannoma surgery.

OBJECTIVE: To evaluate residual tumour occurrence after vestibular schwannoma surgery, based on intra-operative registration and magnetic resonance imaging one year post-operatively. METHODS: Patients undergoing translabyrinthine surgery for vestibular schwannoma in Denmark between 1976 and 2008 were registered in a national database covering 5.5 million inhabitants. RESULTS: Translabyrinthine surgery was undertaken on 1143 patients. Of these, 978 had total, 140 near-total and 25 subtotal tumour excision, as assessed intra-operatively by the surgeon. One year after surgery, 65 per cent of small tumour remnants and 11 per cent of large tumour remnants were not visible on magnetic resonance imaging. The mean pre-operative size was significantly smaller for totally excised tumours, compared with near-totally and subtotally excised tumours. Revision surgery was performed for 14 patients (1.2 per cent), of whom 2 had received total, 5 near-total and 6 subtotal excisions initially. CONCLUSION: Most residual tumours disappear spontaneously, probably due to devascularisation. Few patients with a small residual vestibular schwannoma will require revision surgery or secondary radiotherapy.

Facial nerve palsy caused by parotid gland abscess.

OBJECTIVES: We present the first report of methicillin-resistant Staphylococcus aureus and Propionibacterium acnes parotid abscesses complicated by facial nerve palsy. Facial nerve palsy secondary to parotid gland abscess is rare, with only eight previously reported cases. METHOD: Case reports and literature review concerning parotid abscess and facial nerve palsy presentation and management. CASE REPORTS: Within two months, two female patients presented with parotid gland abscess complicated by unilateral facial paralysis. Both were treated with intravenous antibiotics and surgery. In the first case, methicillin-resistant Staphylococcus aureus was cultivated, in the other, Propionibacterium acnes was found. In the first case, facial nerve function did not recover. CONCLUSION: Parotid gland abscess can lead to facial paralysis. Both methicillin-resistant Staphylococcus aureus and Propionibacterium acnes may be involved. Ultrasonography or computed tomography is recommended to exclude a parotid abscess in patients presenting with suppurative parotitis.

Effect of diathermy on pain and healing in tonsillectomy, compared with other methods of haemostasis: a randomised study.

OBJECTIVE: To compare three methods of haemostasis used for 'cold steel' tonsillectomy, in terms of pain scores and morbidity. METHOD AND MATERIAL: Prospective, randomised, single-blinded, controlled clinical study. Three haemostasis methods were compared: compression of the tonsillar fossae with gauze packs; bipolar diathermy; and local anaesthesia then pack compression. The outcome measures were pain scores (derived from a visual analogue scale), peri-operative bleeding, and post-operative episodes of blood-stained saliva, consultation rate, tonsillar bed healing and days before return to regular diet. One hundred and five patients were included. RESULTS: Peri-operative bleeding was significantly reduced in the local anaesthesia group compared with the other two groups. Delayed post-operative tonsillar bed healing was noted in the diathermy group. No other significant differences were found between the three haemostasis groups, for any other outcome measures. The presence of blood-stained saliva was associated with higher pain scores. CONCLUSION: Diathermy and compression were associated with similar post-tonsillectomy morbidity.

ISDN based teleradiology and image analysis with the software system KAMEDIN.

This contribution describes the software system KAMEDIN (Kooperatives Arbeiten und MEdizinische Diagnostik auf Innovativen Netzen) that is designed as an ISDN based computer supported cooperative work (CSCW) tool for usage in medical diagnostics. Medical image data from various sources (for example CT and MR) can be interchanged and analyzed in bilateral teleconferences via ISDN. During a cooperative session, user interactions for image processing etc., are synchronized and performed on both workstations, Features like telepointing, remote control, and audio connection enhance communication quality. With ISDN as a transmission line, widespread availability and low communication costs are achieved. Further, automatic tissue labeling in intracranial MR data can be invoked. For this purpose, artificial neural network classifiers such as multilayer perceptron and Kohenen feature map are integrated. Classification results can be viewed as 3D-reconstructions.

Hemodynamics at rest and during exercise in 222 patients with coronary heart disease before and after aorto-coronary bypass surgery.

In 222 patients with coronary heart disease hemodynamics at rest and during exercise were measured before and after aortocoronary bypass surgery. A total of 552 grafts were constructed, i.e. an average of 2.47 grafts per patient. Only 10.8% of the patients had a 1-vessel-disease, 59.2% had a 3-vessel-disease. 10.8% of the patients were provided with one graft, 49.7% got 3 or 4 grafts. In 92.8% of the patients the r. desc. ant. was significantly stenosed, and in 94.2% this vessel has been provided with a graft. Preoperatively only 7 patients had no angina pectoris during exercise (bicycle ergometer in supine position, each load lasting 6 min), postoperatively 154 patients have been completely free of angina pectoris. The preoperative angina pectoris-free exercise tolerance was 27.4 +/- 27.4 W (means +/- SD), postoperatively it was 76.5 +/- 33.8 W. The largest increase of exercise tolerance was observed in patients with a 3-vessel-disease (208%). Preoperatively only 10.1% had normal values of pulmonary wedge pressure and cardiac output at rest and during exercise, postooperatively 51.5%. The postoperative normalization of hemodynamics depends on the number of vessels involved (1-vessel-disease 86%, 3-vessel-disease 39.8% normalization) and on the status of the left ventricle (without a previous transmural myocardial infarction 68.4%; with a previous myocardial infarction 41.0%). The effects of revascularization on myocardial ischemia can be evaluated by measurements of pulmonary wedge pressure and cardiac output at rest and during exercise.