[Prospective study on injuries of the German national ice hockey teams in more than 1000 games]. / Prospektive Studie über Verletzungsmuster der Deutschen Eishockeynationalmannschaften bei über 1000 Länderspielen.

Due to the fast and physical nature of the game, prevention of injuries is an important issue in ice hockey. The injuries of the German male senior and junior (U16, U17, U18, U19, U20) national ice hockey teams were documented and analyzed in 1006 games between 1986 and 2006. This unique long observation period over 20 years, as well as the standardized protocol of documentation provides reliable data concerning injury pattern in German international ice hockey. Overall 277 injuries were recorded. Comparing the first and the last ten years of observation, the number did not decline over the time, despite various national and international efforts of injury prevention. The majority of the injuries, almost 60%, were caused by body contact with increasing tendency. Remarkably, the injuries with no body or puck/stick contact more than doubled in the last ten years compared to the first ten years of observation. Most injuries happened to the extremities with decreasing tendency to lower body and increasing tendency to upper body injuries. The number of head injuries did not change significantly. More injuries occurred in the second and third period compared to the first period of the game. The data of this study indicate that many injuries might be due to insufficient physical condition with consecutive lack of concentration and coordination. Players do not seem to meet the increasing technical and athletic requirements of international ice-hockey. The increasing speed and physical energy in international ice-hockey make the game unique and fascinating. Therefore, the aim must be to decrease the number and above all the severity of injuries by further development and adjustment of the player's equipment. Also, a better cooperation of players, coaches, sports medicine and referees seems to be necessary for injury prevention in the future.

Intravenous chemotherapy with cisplatin for regional lymph node metastases of auricular VX2 carcinoma.

INTRODUCTION: The VX2 carcinoma is well established as a useful model for studies on treatment of primary tumors of various locations including the rabbit's auricle; however, limited experience exists on the treatment modalities of lymph node (LN) metastases. In this investigation we studied the frequency and extent of lymphogenic metastatic spread of auricular VX2-carcinomas and their response to systemic chemotherapy. MATERIALS AND METHODS: Induction of a right-sided auricular VX2-carcinoma in 17 healthy New Zealand white rabbits was followed by ablation of the right auricle and intravenous application of 1 mg/kg KG CDDP (cisdiamminedichloroplatinum (II)) dissolved in 2 ml NaCl via the left-sided auricular vein in 10 rabbits (group 1), while 7 rabbits (group 2) remained untreated. After a 24-day follow-up period, animals of both groups were sacrificed and the regional draining LN as well as the lungs were isolated and examined histopathologically. RESULTS: Group 1. Following intravenous cisplatin therapy (ICT), 6/10 animals showed no vital tumor cells within LN metastases of the first draining LN station, while 4/10 animals had necrotic LN metastases limited to the parotideal LN. Group 2. All 7 animals showed necrotic LN metastases of the first and second draining LN station as well as pulmonary metastases. CONCLUSION: The auricular VX2-carcinoma, characterized by frequent lymphogenic metastatic spread and response of LN metastases to ICT, offers an excellent animal model for further studies on the optimised treatment of lymphogenic metastatic spread in HNSCC.

Significant correlation of matrix metalloproteinase and macrophage colony-stimulating factor serum concentrations in patients with head and neck cancer.

Serum matrix metalloproteinases (MMPs) and the macrophage colony-stimulating factor (M-CSF) are of potential interest as serum tumor markers in various malignancies. There is still a lack of reliable tumor markers in patients with squamous cell carcinoma of the head and neck (SCCHN). Therefore, the tumor marker potential of MMPs and M-CSF was investigated in these malignancies. Serum of 59 patients suffering from SCCHN and of 59 healthy volunteers was obtained. The concentration of MMP-3, MMP-8, MMP-9, and M-CSF was determined by sandwich enzyme immunoassays. The MMP- 3, -8, -9, as well as the M-CSF serum concentrations were significantly elevated in the patient group, compared to the healthy controls (p<0.001, p<0.05, p<0.001, p=0.002). There was significant correlation between the M-CSF and the MMP-3 serum concentration (p<0.0001), and between the M-CSF and the MMP-8 serum concentration (p=0.005). A significant correlation with the tumor stage was found only for MMP-8. MMP and M-CSF serum concentrations are of potential interest as serum tumor markers in SCCHN.

Extent of surgical intervention in case of N0 neck in head and neck cancer patients: an analysis of data collection of 39 hospitals.

In the discussion on the treatment of the clinical N0 neck in head and neck cancer, the sentinel lymphonodectomy is gaining more and more in significance. Prior to a multicentre study on the value of sentinel lymphonodectomy, it seemed to be desirable to collect data on the current practice of neck dissection in German ENT departments. First a standardised questionnaire was sent to 50 hospitals in Germany. It contained questions on the respective therapeutic concepts (uni- or bilateral modified radical neck dissection versus selective neck dissection, wait-and-see policy) in histologically proven squamous cell carcinoma (G2) and defined localisation of the primary tumour (T1-T2 carcinoma of the oral cavity, the oropharynx and hypopharynx as well as larynx). Summing up the evaluation of 39 anonymously answered questionnaires, it can be stated that no uniform therapeutic concept for the treatment of the cervical lymph nodes in carcinomas of the upper aerodigestive tract based on the stage of lymphatic metastatic disease exists. It seems to be essential to elaborate such a concept in order to be able to compete in the international context. Likewise, a widespread uniform therapeutic strategy would be the basic prerequisite for the initiation and realisation of multicentric therapy studies.

The auricular VX2 carcinoma--an animal model for sentinel node concept.

BACKGROUND: Considering the increasing clinical significance of the sentinel node (SN) concept, the applicability of the auricular VX2 carcinoma as an animal model for simulation of the SN concept was evaluated. MATERIALS AND METHODS: By means of blue dye and immunofluorescence-marked colloids, the lymphatic drainage of the auricle was described in 8 New Zealand white (NZW) rabbits. In 28 NZW rabbits, the extent of metastatic spread of auricular VX2 carcinomas after 8, 18, 21, 28 and 32 days of tumor growth was examined. RESULTS: Lymphogenic metastatic spread was limited to the parotideal lymph node functioning as SN for 21 days. The disintegration of the physiologic integrity of the SN leads to metastatic spread in the area of the secondary lymph node station after 28 days of tumor growth with successive hematogenic spreading. CONCLUSION: The auricular VX2 carcinoma in NZW rabbits is an appropriate animal model for simulation of the lymphogenic metastatic spread and the SN concept in HNSCC.

Expression of MMP-2, -9 and -13 in cell lines and fresh biopsies of squamous cell carcinomas of the upper aerodigestive tract.

BACKGROUND: The expression patterns of the matrix metalloproteinases (MMP) 2, 9 and 13 have been examined in biopsies and cell lines of squamous cell carcinomas (SCC) of the upper aerodigestive tract to determine the association between MMP expression and the aggressiveness of the tumor. MATERIALS AND METHODS: The expression of MMP-2, -9 and -13 was analyzed by immuno-hybridization in 12 keratinocyte cell lines, 13 SCC cell lines and in 63 biopsies from SCCs of the upper aerodigestive tract. RESULTS: In biopsies a correlation was detected between T-status and the MMP expression [MMP-2 (p < 0.05), MMP-9 (p < 0.01), MMP-13 (p < 0.01)], between N-status and MMP expression [MMP-2 (p < 0.05), MMP-9 (p < 0.01)] and between UICC stage and MMP-9 expression (p < 0.01). CONCLUSION: The MMP-2, MMP-9 and MMP-13 expressions correlate strongly with pathological parameters. The determination of these tumor-biological parameters could help to identify high risk patients with increased frequency of metastatic spread.

Macrophage colony-stimulating factor as a tumor marker for squamous cell carcinoma of the head and neck.

It has been demonstrated that in patients with epithelial ovarian cancer and malignant germ cell tumors of the ovary, macrophage colony-stimulating factor (M-CSF) is significantly elevated in the serum compared to healthy individuals. Therefore, M-CSF has been suggested as a tumor marker in these malignancies. In the present study, the tumor marker potential of the serum M-CSF concentration in patients with squamous cell carcinomas of the head and neck (SCCHN) was investigated. The serum M-CSF concentration was determined by a quantitative sandwich enzyme immunoassay in 59 patients suffering from SCCHN and 59 healthy controls. A significant difference in the mean serum concentration of M-CSF between the patients with SCCHN and the control group was found (p = 0.002). The M-CSF serum concentration correlated neither with the stage of disease nor with histopathological grading, and no correlation with serum C-reactive protein was found. The serum M-CSF concentration could be of interest as a tumor marker in SCCHN.

Follow-up with serum Cyfra 21-1 in patients with squamous cell carcinomas of the head and neck.

OBJECTIVE: Finding tumor markers for disease progression, and especially development of distant metastases, is desirable for patients with squamous cell carcinoma of the head and neck (SCCHN). Elevated serum levels of Cyfra 21-1 (cytokeratin fraction 21-1) have been frequently associated with disease progression in patients with lung cancer. In SCCHN, Cyfra 21-1 has not been established as a routine tumor marker yet, probably due to difficulties in finding the appropriate cut-off for the serum level. The aim of this study was to investigate whether assessment of changes in serum Cyfra 21-1 over time can predict distant metastases in patients with SCCHN, without attempting to establish an arbitrary cut-off for abnormal levels. METHODS: Cyfra 21-1 serum levels of 25 patients with SCCHN and distant metastases were evaluated by means of an ELISA test kit. RESULTS: There was a wide range of Cyfra 21-1 serum levels at the time of primary diagnosis, without correlation with tumor size, lymph node status, time to recurrence, or presence of distant metastases. All patients had a clear increase of Cyfra 21-1 levels which preceded the appearance of distant metastases clinically. CONCLUSIONS: Due to the wide range of Cyfra 21-1 levels at the time of primary tumor diagnosis, Cyfra-21-1 is neither a suitable screening marker for SCCHN, nor for diagnosis of distant metastases at the time of initial diagnosis of the tumor, but is of evident prognostic value for follow-up, especially for early detection of distant metastases.

Tumor marker potential of serum matrix metalloproteinases in patients with head and neck cancer.

BACKGROUND: Elevated expression of matrix metalloproteinases (MMPs) is suggested to have tumor marker potential in various tumors. MMPs are capable of disintegrating the basement membrane, which is a main characteristic of tumor invasion. They are specifically inactivated by tissue inhibitors of metalloproteinases (TIMPs). Squamous cell carcinomas of the head and neck (SCCHN) are known to be highly invasive tumors with early locoregional metastatic spread. PATIENTS AND METHODS: To investigate the tumor marker potential of MMPs in SCCHN, MMP-2, -3, -8, -9, -13 and TIMP-1 serum levels were determined in 73 patients and compared to 74 controls. A correlation with T- and N-status, UICC-staging and grading was performed. Additionally, the influence of inflammation on the MMP serum concentration was examined. RESULTS: Significant differences between patients with SCCHN and controls were seen for MMP-3, -8 and -9. A significant correlation was found between MMP-8 concentration and T-status, N-status and UICC-staging. No correlation with the grading of the tumor was observed. Inflammatory diseases did not affect MMP and TIMP levels significantly. CONCLUSION: Some MMPs are elevated in the serum of patients with SCCHN and especially MMP-8 showed interesting tumor marker potential.

Severe cardiotoxicity during 5-fluorouracil chemotherapy: a case and literature report.

The chemotherapeutic agent 5-fluorouracil (5-FU) is a widely accepted part of many cancer treatment protocols. Its cardiotoxic potential is known, but considered uncommon and usually not life threatening, although some cases of severe cardiotoxicity related to 5-FU have been reported. The pathogenesis of cardiotoxicity caused by 5-FU is not clear. We report a case of sudden onset of severe cardiac failure, without ischemic symptoms or signs, during 5-FU treatment with serious consequences, in a previously healthy 23-year-old patient with squamous cell carcinoma of the tongue. Endomyocardial biopsy showed proliferation of the sarcoplasmic reticulum with marked vacuolization, similar to that found with doxorubicin cardiotoxicity. Because 5-FU cardiotoxicity is unpredictable and can have potentially fatal consequences, it requires, in our opinion, further clarification. With this well-documented case, including an endomyocardial biopsy, we hope to encourage additional efforts to investigate the pathophysiologic mechanisms of 5-FU cardiotoxicity.

Prognostic significance of p27 expression in carcinoma of the oral cavity and oropharynx.

OBJECTIVE: To study the role of p27, a cyclin-dependent kinase inhibitor, as a prognostic indicator in squamous cell carcinoma of the oral cavity and oropharynx. STUDY DESIGN: Retrospective review of 35 patients with squamous cell carcinoma of the oral cavity and oropharynx who presented to Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, between 1986 and 1995. METHODS: Inclusion criteria were the availability of clinical information, archival pretreatment biopsy material, and a minimum follow-up of 24 months. p27 staining was scored for frequency and intensity of tumor cell expression following immunoperoxidase staining using standard techniques. Samples of squamous epithelium from the uvula of 15 nonsmoking patients without past or present squamous cell carcinoma were used as normal controls. RESULTS: The association of p27 staining and other factors with response to treatment was evaluated by Fisher's Exact Test and with overall and disease-free survival by the Kaplan-Meier method with multivariate Cox regression. Low levels of p27 expression correlated significantly with unfavorable treatment response (P<.0001), shorter overall survival (P = .0001), and shorter disease-free survival (P = .003). Tumor site (alveolus) was also associated with shorter disease-free (though not overall) survival, but the association with p27 was independent of stage and site in multivariate analysis.

Proliferation marker Ki-S11--a prognostic indicator for squamous cell carcinoma of the hypopharynx.

As a potential prognostic factor, the proliferative activity of 131 squamous cell carcinomas (SCC) of the hypopharynx and 47 of their cervical lymph-node metastases was analyzed retrospectively by means of monoclonal antibody Ki-S11 immunostaining, which specifically detects the Ki-67 antigen on paraffin-embedded tissue. Median follow-up time was 37.6 months. Ki-S11 revealed distinctive patterns of proliferating cells related to the degree of differentiation. The proliferation fractions in the primaries and their lymph-node metastases did not differ significantly. Patients with high proliferating hypopharynx carcinomas (>45% labeled cells) had a significantly lower 5-year-survival rate (16%) than patients with low proliferating tumors, whose 5-year-survival rate was 30% (P=0.01). A statistically significant positive correlation was also observed between proliferative activity and lymph-node status (P=0.012). In conclusion, the proliferative activity as determined by means of Ki-S11 immunostaining is of prognostic value with respect to both survival and metastatic risk in SCC of the hypopharynx.