Second primary malignancies in head and neck cancer patients: high prevalence of curable-stage disease.

BACKGROUND AND PURPOSE: Patients treated for squamous cell carcinoma of the head and neck (HNSCC) carry a high risk of second primary malignancies (SPM). Recently, computed tomography (CT) of the chest was shown to significantly decrease the risk of death due to bronchial carcinoma (BC) in a cohort of smokers whose risk of BC is increased but might be lower than that of patients previously treated for HNSCC. Thus, the present study evaluated the potential benefit of CT and other examinations in the detection of SPM in HNSCC patients. PATIENTS AND METHODS: Between July 2008 and November 2011, 118 participants underwent a prospective, systematic examination for SPM (13 women, 105 men, median age 62 years). All patients had been previously treated for HNSCC and showed no recurrence or distant metastases at the time of the study start. CT scans, ear-nose-throat endoscopy, and endoscopy of the esophagus and stomach were performed. RESULTS: Overall, 33 suspicious findings were clarified by additional investigations. In all, 26 SPM were confirmed in 21 of 118 patients (18%; 10 lung, 7 HNSCC, 3 gastrointestinal, 1 renal). Eighteen of these 21 patients (86%) underwent therapy with curative intent. CONCLUSION: The examinations revealed a high prevalence of curable stage SPM in HNSCC patients. Adapting a surveillance scheme including a chest CT is recommended.

[Abdominal free air without signs of perforated abdominal viscus during non-invasive ventilation]. / Freie abdominelle Luft ohne Hinweis auf eine Hohlorganperforation unter nichtinvasiver Beatmung.

HISTORY: A 19-year-old patient suffering from Duchenne muscular dystrophy was admitted to our hospital with an acute bronchopulmonary infection. Four months ago noninvasive ventilation was started because of hypercapnic respiratory failure. Mechanical ventilation had been used so far only at night. At the time of admission spontaneous breathing was not possible due to exhaustion of the respiratory muscles. The patient suffered from fever, limited cough strength and dyspnoea at rest. The abdomen was distended because of intestinal gas without clinical signs of acute abdomen. INVESTIGATIONS: Blood gas analysis showed respiratory acidosis even under mechanical ventilation. Laboratory tests showed an elevation of the inflammation indicating parameters. X-rays of the chest showed elevated diaphragms. Within the next days pneumonia could be seen in the left lower lobe. The patient had to be under mechanical ventilation almost 24 hours per day. Hypercapnia and respiratory acidosis normalized and the patient was able to breathe spontaneously for longer periods. The following days cutaneous emphysema developed and X-rays revealed free abdominal air on day 9 of the hospital stay. DIAGNOSIS, TREATMENT AND COURSE: The radiological findings have been confirmed during follow up X-rays without any clinical correlate. Inflammatory markers were decreasing. After the pneumonia had healed almost completely, the times on mechanical ventilation could be reduced. Subphrenic air resolved completely without any intervention. CONCLUSION: Free subphrenic air without any clinical signs of acute abdomen does not necessarily force a surgical exploration. Under frequent follow up investigations a wait-and-see strategy could be justified. An explanation for the subphrenic air could be an interstitial emphysema due to increased intrathoracic pressure caused by the prolonged noninvasive ventilation, releasing the air through the diaphragmatic gaps into the abdomen.

Angiotensin II blockers in obstructive pulmonary disease: a randomised controlled trial.

In chronic obstructive pulmonary disease (COPD), the sympathetic nervous system, as well as the renin-angiotensin system, is activated with possible negative systemic effects on skeletal muscles. Angiotensin II type-1 receptor blockers inhibit the sympathetic and renin-angiotensin systems and might improve skeletal and respiratory muscle strength in patients in whom these systems are activated. The effects of the angiotensin receptor blocker irbesartan given over 4 months was evaluated in 60 patients with COPD and a forced expiratory volume in one second of <50% of the predicted value and without obvious cardiovascular disease that would necessitate the administration of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Irbesartan was well tolerated, but did not exert a significant effect on the primary end-point maximum inspiratory pressure. Spirometric results were not affected, but total lung capacity was reduced. Irbesartan led to a significant decrease in haematocrit (46.4+/-3.6 to 43.9+/-4.3% versus 47.5+/-2.4 to 48.7+/-3.0% with placebo). In conclusion, respiratory muscle strength in chronic obstructive pulmonary disease patients was not influenced by angiotensin II receptor blockade. However, the changes in haematocrit and total lung capacity following irbesartan raise the possibility that well-known cardiovascular drugs can produce unanticipated beneficial effects in chronic obstructive pulmonary disease patients.

[Endotracheal complications after long-term ventilation. Noninvasive ventilation in chronic thoracic diseases as an alternative to tracheostomy]. / Endotracheale Folgen der Langzeitbeatmung--Nichtinvasive Beatmung bei chronisch thorakalen Erkrankungen als Alternative zur Tracheotomie.

PATIENTS AND METHODS: In this present retrospective study we examined 62 long-term ventilated patients, whose weaning from respirator failed, for endoscopic airway complications and the frequency of consecutive surgery required. Furthermore noninvasive volume-controlled intermittent ventilation was evaluated as an alternative method to tracheostomy for maintaining mechanical ventilation and weaning of patients with chest wall disorders, neuromuscular and chronic obstructive lung disease. RESULTS: 25 patients with endotracheal tube and 37 with tracheostomy who had been long-term ventilated in different intensive care units for 18 +/- 12 respectively 57 +/- 27 days (19 +/- 12 days via endotracheal tube) could be weaned successfully consequently using a volume-controlled intermittent ventilation via an individually adapted face mask. We found 2 patients of the group with endotracheal intubation (median age 59 +/- 15 years, 11 female, 14 male, median duration of mechanical ventilation via tube 18 +/- 12 days) to have visible injuries of the respiratory tract without consecutive surgery being necessary. All of them were successfully weaned from respirator via noninvasive ventilation (in 2 of them completely spontaneous breathing was re-established, 23 patients needed intermittent ventilation at home). Of the 37 patients with tracheostomy (median age 59 +/- 15 years, 15 female, 22 male, median duration of mechanical ventilation 57 +/- 27 days, tracheostomy on day 19 +/- 12) 19 cases (51%) showed endoscopically visible injuries of the respiratory tract of whom 7 cases (19%) were severe and made consecutive surgery necessary. 29 patients were discharged with noninvasive ventilation at home, 5 needed further invasive ventilation via tracheostomy and 3 patients breathed spontaneously without ventilatory support. The incidence of severe tracheal stenosis following long-term ventilation via tracheostomy was nearly 20% (1 tracheoesophageal fistula) and needed surgical treatment. CONCLUSION: As even duration of ventilation via tracheal tube and mode of ventilation before transfer to our clinic was comparable in both groups noninvasive ventilation is an appropriate alternative to tracheostomy following endotracheal intubation for maintaining ventilatory support, especially for patients with chronic ventilatory insufficiency.

Quantitative measurement of adenosine deaminase from human erythrocytes.

Methods for measuring enzymatic activity of adenosine deaminase from human erythrocytes were examined and compared with each other. Determination of ADA by the method in which adenosine is converted into inosine with uric acid as the final product by the action of nucleoside phosphorylase and xanthine oxidase appears to yield the most reliable results. In the recommended assay saponin is used for lysis of erythrocytes when testing adenosine deaminase activity in red blood cells. Storage of erythrocyte samples is optimal at +4 degrees C; storage at room temperature or at -20 degrees C leads to loss of adenosine deaminase activity.