[Rhinosporidiosis. A rare cause of nosebleed]. / Rhinosporidiose. Eine seltene Ursache für Nasenbluten.

Due to an increasing number of non-European patients and tourists travelling in endemic aras, "exotic" mycosis and other tropical diseases must be considered in differential diagnosis. In this report we present a patient with epistaxis caused by rhinosporidiosis, an endemic disease in South India and Sri Lanka (Ceylon) and quite rare in Europe. This chronic inflammatory disease characterized by hyperplastic polypoid lesions of the mucous membrane, predominantly nasal, is caused by Rhinosporidium seeberi, a parasite with a complicated life cycle and an uncertain taxonomy. The commonest and often the presenting symptom is epistaxis. The treatment of choice is surgery with risks of recurrence.

Proliferating cell nuclear antigen counts as markers of cell proliferation in head and neck cancer.

Proliferating cell nuclear antigen (PCNA) expression was investigated immunhistochemically in 53 squamous cell carcinomas of the head and neck. PCNA is a 36-kDa nuclear protein associated with the cell cycle. Results were compared with Ki67 counts, with this latter marker used to demonstrate proliferative compartments. Overall, the PCNA and Ki67 labelling index showed a similar distribution pattern in normal and tumor tissue. A strong correlation was found to histological differentiation. There was no significant difference between PCNA and Ki67 counts (r = 0.8), and PCNA immunostaining allowed assessment of proliferative activity in the head and neck cancers studied. The application of formalin-fixed, paraffin-embedded tumor material demonstrated the advantage of this method and showed that it is an excellent alternative to Ki67 counts.

[Epidermal growth factor (EGF) receptors in squamous cell carcinoma of the head and neck region]. / Epidermal Growth Factor (EGF)-Rezeptoren bei Plattenepithelkarzinomen aus dem Kopf-Hals-Bereich.

The expression of epidermal growth factor receptors (EGFR) has been studied immunohistochemically in 66 squamous cell carcinomas of the head and neck. All investigated tumours overexpressed EGFR showing a homogenous distribution pattern. Pretreatment of tumours (eg. chemotherapy or radiation) did not influence this result. Our findings indicate that EGFR expression is not strongly correlated to proliferative activity, and is not suited to be used as a prognostic marker. It is possible that the observed overexpression of EGFR in squamous cell carcinomas of head and neck can be used as a target for ligand-complexed drugs.

[Clavicular fractures after radical neck dissection]. / Klavikulafrakturen nach radikaler Neck dissection.

Fracture of the medial end of the clavicle as a late complication following radical neck dissection is rare, with an incidence of approximately 0.4%-0.5%. Radical neck dissection alters the mechanics of the shoulder girdle, and distorts normal muscle forces acting on the clavicle. We present two patients to illustrate the problems of differential diagnosis and mechanism of fracture. Once the diagnosis has been made the fracture should be managed conservatively, although clinical and radiological differentiation from avascular necrosis or bony metastasis may be difficult. Biopsy is essential in doubtful cases.

[Transferrin receptors in squamous epithelial cancers of the head and neck]. / Transferrinrezeptoren in Plattenepithelkarzinomen aus dem Kopf-Hals-Bereich.

Transferrin ist the transport protein of iron known to be an essential element of life. Iron transport crossing the cell membrane is mediated by the specific transferrin receptor (TR). However, the receptor was observed especially in proliferating tissues. We examined immunohistochemically the distribution pattern of this receptor in 60 squamous cell carcinomas of the head and neck. The results were correlated with their proliferative activities determined by the monoclonal antibody Ki67. All investigated tumors expressed the TR mostly distributed homogeneously with slight intra- and intertumorous differences. Generally with increasing expression of TR we could observe a decrease of the histopathological grading of the tumors investigated in our series. However, this relation could not be verified in all our cases. Therefore, only a semiquantitative analysis seemed to be reasonable. Our results indicate that the expression of TRs is not strongly associated to proliferative activity and cannot be used for measurements of growth fractions in squamous cell carcinomas.

[Tumor-associated macrophages (TAM) in the stroma of squamous cell carcinomas of the ENT area studied using monoclonal antibodies]. / Untersuchungen über tumorassoziierte Makrophagen (TAM) im Stroma von Plattenephitelkarzinomen des HNO-Bereiches mit Hilfe von monoklonalen Antikörpern.

Monoclonal antibodies were used to examine the presence and nature of tumor associated macrophages and T-lymphocytes in 26 cases of squamous cell carcinoma of head and neck. The content of macrophages varied according to the differentiation of the carcinoma: high differentiation was evidenced by a labelling index by an index between 13.5% and 23.7%, poor differentiation from 27.4% to 35.8%. T-lymphocytes were found where tumors were inflamed, but there was no significant correlation between tumor differentiation and infiltrating T-lymphocytes. The present results that prognosis decreases with the increasing number of tumor associated macrophages in squamous cell carcinoma.

[Prolongation of the QT interval in the ECG following surgery of the neck (neck dissection)]. / Untersuchungen zur Verlängerung der QT-Zeit im EKG nach Operationen am Hals (Neck dissection).

The QT interval on the ECG was determined in 40 patients undergoing major resection plus neck dissection. The readings were taken before operation, between 1 and 3 h after operation, and the 1st and the 7th day after the operation. The QT interval was prolonged significantly more often and more intensively in patients undergoing surgery on the right side (from 411 +/- 17 to 459 +/- 50 ms) than in those operated on the left side (409 +/- 14 to 431 +/- 32 ms; all values mean +/- SD). The cause of the prolongation of QT interval is thought to be either direct surgical damage to the sympathetic cardiac nerves during the operation, or a temporary disturbance of nerve function due to pressure, tension or oedema in the wound. An explanation for the observed side difference might be differing functional effects of right- and left-sided sympathetic innervation of the heart. Attention is drawn to the meaning of these findings as a predisposing factor for ventricular tachyarrhythmias.

Sudden sensorineural hearing loss influence of hemodynamical and hemorheological factors on spontaneous recovery and therapy results.

The effect of a hemodilution therapy for sudden sensorineural hearing loss was analysed comparing the results of a prospective randomised double blind study and a retrospective study at the Frankfurt university. The prospective study consists of a treatment group receiving infusions with hydroxyethyl starch-pentoxifyllin and a control group with infusions with normal saline. Another patient group receiving hydroxyethyl starch-pentoxifyllin-naftidrofuryl infusions was analysed retrospectively. The overall therapy results are in the same range for all 3 groups. However patients with a hemoglobin value above 14 mg % in the control group had a poorer result compared to the other groups. The patient group with systolic blood pressure above 130 mm Hg treated with hydroxyethyl starch-pentoxifyllin had a significant hearing improvement over normal saline and hydroxyethyl starch-pentoxifyllin-naftidrofuryl. With increasing systolic blood pressure, patients in the control and hydroxyethyl starch-pentoxifyllin-naftidrofuryl groups had a statistically significant lower therapy result.

Radiosensitizing with cis-platin in advanced head and neck cancer. Results and problems.

Treatment consisting of surgery and/or radiation therapy for patients with squamous cell carcinoma of the head and neck has frequently been successful in earlier stages of disease. Advanced and non-resectable tumor stages have a very poor cure rate. We initiated this trail to assess the role of the potentiation between cis-PDD and radiation previously reported in advanced head and neck tumors. Eighteen patients were investigated in this study. The treatment consisted of cis-PDD and hyperfractionated radiotherapy. Seventeen (94%) of the patients responded to the treatment regimen with either a complete regression (5/18 = 33%) or a partial regression (11/18 = 61%) of the tumor. Median survival was short and lasted 12+ months among complete responders and 8+ months among partial responders. However all patients did experience an increased and not tolerable incidence of delayed radiation toxicity such as mucositis combined with necrotic stomatitis. Both complications limited the compliance to the therapy. Because of these complications we had to stop the ongoing study.

Proliferation-associated monoclonal antibodies: a useful tool for prognosis in squamous cell carcinomas of head and neck?

Three different proliferation-associated monoclonal antibodies have been studied immunohistochemically to evaluate their prognostic value in patients with squamous cell carcinomas of head and neck. The monoclonal antibody Ki 67 shows a heterogeneous distribution pattern, whereas epidermal growth factor receptor and transferrin receptor expression show a homogeneous one. Concluding from our results the chances to use the described monoclonal antibodies as prognostic markers are limited.

[Determination of cell proliferation using monoclonal antibodies. Studies of 21 squamous cell carcinomas of the head and neck area]. / Bestimmung der Zellproliferation mit Hilfe monoklonaler Antikörper. Untersuchungen an 21 Plattenepithelkarzinomen aus dem Kopf-Hals-Bereich.

These tumours showed a correlation between Ki 67 labelling index and histological differentiation: poor differentiation resulted in a Ki 67 labelling index from 30 to 50%, high differentiation below 20%. Labelling index of moderately differentiated carcinomas ranged between these values. Pretreatment of tumours, i.e. chemotherapy and radiotherapy, resulted in a labelling index of less than 6%. The observed heterogeneity must be considered as a limitation for using the monoclonal antibody Ki 67 in these cases as a prognostic marker.

Evaluation of proliferative activity in human head and neck tumors using the monoclonal antibody Ki-67.

The monoclonal antibody Ki-67 is directed against a human nuclear antigen occurring in proliferating cells. As a rule it is absent in quiescent cells. Seven cases of squamous cell carcinomas with different pathohistological features are investigated by immunostaining. The antibody Ki-67 is suitable for use as a marker for proliferative compartments of head and neck tumors. Squamous cell carcinomas show a correlation between Ki-67 labeling index and histological differentiation. In highly differentiated parts of the carcinomas, an additional granular immunostaining in the entire cytoplasm of some squamous epithelial cells was observed.