Heightened embarrassability discriminates between panic disorder patients with and without agoraphobia.

Embarrassability refers to an individual's general susceptibility to becoming embarrassed and is closely linked to another personality characteristic known as fear of negative evaluation. To find out if panic disorder patients with and without agoraphobia differ in terms of embarrassability and fear of negative evaluation 100 patients with a DSM-III-R diagnosis of panic disorder with agoraphobia, 30 patients with a DSM-III-R diagnosis of uncomplicated panic disorder and 80 controls were administered the Embarrassability Scale and the 12-item version of the Fear of Negative Evaluation Scale. Depressive mood in the clinical group was assessed with the help of the Beck Depression Inventory. Comparisons between these three groups, between patients with mild, moderate, and severe phobic avoidance and between male and female subjects were carried out. Patients with agoraphobic avoidance showed significantly higher scores on both scales than patients with uncomplicated panic disorder and controls and women generally showed higher embarrassability scores than men. We conclude that heightened embarrassability is an important characteristic of patients suffering from panic disorder with agoraphobia.

Neurofibroma of the auriculotemporal nerve.

Despite the extensive branching of the trigeminal nerve, solitary neurofibromas along its branches are a rare finding. We report our management of a neurofibroma of the right auriculotemporal nerve in a 46-year-old women. A chain of small nodules palpable in the right postauricular region was associated with increasing pain radiating into the postauricular and temporoparietal regions of her head. Magnetic resonance imaging and computed tomography showed several small ovoid lesions extending from the postauricular region to the infratemporal fossa. The lesions were removed surgically. The facial nerve adhered to the dorsal side of the largest nodule, but this could be removed without sequelae. The auriculotemporal nerve was identified as the nerve of origin and was removed together with the lesions. Histopathological examination was consistent with a neurofibroma with early plexiform cell formations. Clinical findings are discussed.

The effect of heat-shocking on batch fermentation by Clostridium beijerinckii NRRL B592.

In spite of the large-scale industrial use of the acetone-butanol fermentation process earlier this century (until 1983 in South Africa), very little has been published on the inoculum preparation techniques required for successful fermentation using these bacteria. In particular, heat-shocking has often been referred to as "useful" but no quantitative data are available. Data presented in this paper demonstrate and quantify the effect of heat-shocking on batch fermentation yields using one organism capable of this fermentation.

Continuous two-stage ABE-fermentation using Clostridium beijerinckii NRRL B592 operating with a growth rate in the first stage vessel close to its maximal value.

A two-stage continuous cultivation experiment with Clostridium beijerinckii NRRL B592 is described. The experiment was designed to mimic the two phases of batch culture growth of the organism in a two-stage continuous process. Thus in the first stage turbidostat the organism was grown acidogenically as rapidly as possible, and transferred to the second stage at the 'acid break point'. The second stage was designed to mimic the solventogenesis of the batch culture when it enters late exponential/early stationary phase. The volume of the second stage vessel was calculated to provide the necessary residence time for complete sugar utilization. It was hoped that the experimental set-up chosen would show whether data obtained from batch fermentation could be transferred directly to continuous culture. The culture maintained its ability to produce acetone, 1-butanol and ethanol at a dilution rate of 0.12 h(-1) for the first stage and 2.2 x 10(-2) h(-1) for the second stage and achieved an average overall solvent concentration of 15 g/l and an overall solvent productivity of 0.27 g/l/h for a period of steady-state operation of more than 1600 hours. The productivity of solventogenesis in the first stage was dependent on the value of the growth rate of the culture which was in turn determined in part by the organism employed but also by the medium composition.

A differential PCR system for the determination of CCND1 (cyclin D1) gene amplification in head and neck squamous cell carcinomas.

The gene for Cyclin D1 (CCND1) lies within chromosomal region 11q13 and codes for a cell cycle regulator essential for G1 phase progression. This G1-cyclin is a putative protooncogene whose clonal rearrangement and/or amplification and mRNA overexpression occurs in several types of human neoplasias, including head and neck squamous cell carcinomas. Data from the literature suggest that amplification and overexpression of the CCND1 gene could lead to destabilisation of cell cycle control mechanisms and uncontrolled cell proliferation. We developed a differential PCR system for the determination of CCND1 gene amplification in head and neck squamous cell carcinomas. A 115 bp CCND1 fragment and a 150 bp gamma-interferon fragment are amplified simultaneously in the same reaction tube under optimized conditions. Statistical analysis of amplification data obtained by differential PCR revealed excellent correlation with amplification data obtained by conventional Southern hybridization.

Diffuse idiopathic skeletal hyperostosis causing obstructing laryngeal edema.

Diffuse idiopathic skeletal hyperostosis (DISH), or ankylosing hyperostosis ("Forestier's disease"), is an ossifying diathesis of unknown etiology. Diagnosis is primarily radiologic: osseous bridging of at least four contiguous vertebral bodies, a radiolucent line between the deposited bone and the anterior vertebral surface, large osteophytes and preservation of disk height especially in the cervical and lumbar spine. Although DISH is found in 6-12% of autopsy cases, clinical features are rare and consist primarily of swallowing disorders. A case of DISH is reported in which excessively enlarged cervical osteophytes led to edema of the laryngeal inlet and consequent severe dyspnea, necessitating emergency tracheotomy. Surgical excision of the osteophytic masses resulted in relief of symptoms. Symptomatology, radiographic features and individual treatments are discussed, with the latter dependent on clinical symptoms.

[Physiology of the larynx]. / Physiologie des Larynx.

The larynx consists of the cartilaginous-osseous framework, elastic membranes and ligaments, joints, muscles, nerves, vessels, and interior cavity. The laryngeal functions are the protection of the airway during swallowing, respiration (i.e. maintainance of the airway) and phonation. During the pharyngeal phase of swallowing the swallow reflex induces a laryngeal closure in three levels and a superior-anterior movement of the larynx and hyoid bone. The laryngeal airway is maintained by the circumference of the cricoid cartilage. Phonation is the phylogenetically recent function of the larynx and was made possible by the laryngeal descent. The sound production is explained according to the myoelastic-aerodynamic theory. The diagnostics of laryngeal diseases is performed in close cooperation between otorhinolaryngology and radiology. For diagnostic purposes, the physiology of the larynx requires to take into account not only morphological, but also functional aspects.

[Diagnosis and therapy of laryngeal carcinoma]. / Diagnostik und Therapie des Larynxkarzinoms.

Therapeutic choice in laryngeal carcinoma is influenced by the nature of the tumor and a variety of factors involving the patient and physician. Small (T1) and exophytic (T1, T2) tumors are suitable for radiotherapy. Limited lesions (T1, T2) can be cured by functional endoscopic resection techniques or external partial laryngectomies. Extensive tumors (large T2; T3) are treated by total laryngectomy or by primary irradiation, especially in the case of a good response to induction chemotherapy. When radiation treatment fails, surgery succeeds in more than half of the cases. Tumors infiltrating or transgressing the laryngeal framework (T4) can only be cured by total laryngectomy followed by radiotherapy. Subtotal or circular ablation of the adjacent pharynx or esophagectomy needs repair with visceral or myocutaneous grafts. Lymphatics are preferentially treated with the same modality as used in the primary disease. Inconspicuous lymphatics should be treated electively in most cases, with the exception of early glottic cancer.

[Postoperative complications after larynx resection: assessment with video-cinematography]. / Postoperative Komplikationen nach Larynxresektion: Abklärung mittels Videocinematographie.

In past decades, the surgical techniques for treating laryngeal carcinoma have been vastly improved. For circumscribed tumors, voice-conserving resections are possible and for extensive neoplasms, radical laryngectomy, sometimes combined with chemoradiation, has been developed. Postoperative complications regarding swallowing function are not uncommon. Radiologic examinations, especially pharyngography and videofluoroscopy, are most often used to evaluate patients with complications after laryngeal surgery. An optimized videofluoroscopic technique for evaluation of complications is described. The radiologic appearance of early and late complications, such as fistulas, hematomas, aspiration, strictures, dysfunction of the pharyngoesophageal sphincter, tumor recurrence, and metachronous tumors is demonstrated.

Treatment of a local recurrence of a carcinoid tumor of the middle ear by extended subtotal petrosectomy.

A recurrence of a primary carcinoid tumor of the middle ear 15 years after radical tympanomastoidectomy is reported. An extended subtotal petrosectomy using a craniocervical approach with temporary infracondylar mandibulotomy was performed, since imaging studies demonstrated an extensive tumor with a close relationship to the tegmen tympani, facial nerve, and ascending and horizontal portions of the carotid canal. The tumor was metabolically inactive. Histopathological examination showed a solid, trabecular tumor that was positive for pancytokeratin Lu5, neuron-specific enolase, pancreatic intestinal polypeptide and glucagon. Neuroendocrine-granules were demonstrable under electron microscopy. This case is reported to show that primary middle-ear carcinoid tumors can recur years after radical tympanomastoidectomy.

Prognostic factors for swallowing rehabilitation following head and neck cancer surgery.

Thirty-two head and neck surgical patients with prolonged moderate to severe aspiration were assessed with videoendoscopic and videofluoroscopic swallowing studies to reveal all components of dysphagia and aspiration. All patients received functional swallowing therapy, and 75% of the patients regained full oral intake diet. The duration of non-oral feeding varied widely. The outcome of swallowing rehabilitation (success or failure, duration of non-oral feeding) was statistically correlated with preoperative tumour stage, patients' age, therapy onset, severity of aspiration and the results of the videofluoroscopic measurements of oral and pharyngeal transit time, pharyngeal delay time, duration of laryngeal closure and cricopharyngeal opening, hyoid and laryngeal elevation, presence or absence of a stenosis at the pharyngoesophageal segment. The following factors proved to be statistically significant for the prognostic estimate of swallowing rehabilitation: preoperative tumour stage, therapy onset, and severity of aspiration. For postoperative swallow recovery, an early therapy onset after thorough diagnostics with videoendoscopic and videofluoroscopic swallowing studies is recommended. Videofluoroscopic measurements will yield some prognostic estimate of oropharyngeal dysphagia and aspiration. Videoendoscopy, by it's availability and immediacy, proved to be useful for monitoring the course of rehabilitation.

[Late functional outcome after reconstruction of the upper aerodigestive tract with free transplanted microvascular anastomosed jejunum]. / Funktionelle Spätergebnisse nach Wiederherstellung der oberen Atem- und Schluckwege mit frei transplantiertem mikrovaskulär anastomosiertem Jejunum.

Since 1983, 90 autologous jejunal transplantations for reconstruction of the upper digestive tract have been performed in 89 patients (9 females, 80 males, average age 56.3 years). 73 patients were operated primarily, in 16 patients a recurrent tumor had been treated. One patient received a second jejunal graft after necrosis. In these heterogenous patients, the primary tumor was located in the hypopharynx 48 times, in the larynx 21 times, in the oropharynx 19 times and twice in the oral cavity. There was nearly always tumor stage III or IV without distant metastases. Following locoregional tumor resection, speech restoration was achieved 35 times by a siphon-like tube, and the upper digestive tract was reconstructed using a patch 18 times and by a tube 28 times. A combination of tube or patch with a siphon-like tube was employed 9 times. In only two of 16 patients with recurrent tumor, speech reconstruction was performed, in the other 14, the upper digestive tract was reconstructed. In those patients, in whom speech reconstruction (by siphon tube or by combination with tube/patch) was intended, this was achieved in 81.5%. Successful functional reconstruction of the upper digestive tract (by patch, tube, combination) could be achieved in about 60% of these patients.

[Soft tissue sarcomas of the ENT area. A report of experiences of the Vienna University ENT Clinic]. / Weichteilsarkome im HNO-Bereich. Ein Erfahrungsbericht der Univ.-HNO-Klinik Wien.

BACKGROUND: Soft-tissue sarcomas of the head and neck are rare. Local recurrence is common, and wide excision is thought to be the mainstay of treatment. Surgical radicality is limited by the vicinity of vital organs. Improvement of cure rates therefore is expected mainly from combined treatment modalities. METHOD: Retrospective analysis of 32 cases of soft-tissue sarcoma on file at the Department of Otorhinolaryngology of the University of Vienna between 1954 and 1994. RESULTS: The most frequent descriptive histological diagnosis was polymorphic cell sarcoma in 11 cases. An immunohistological verification was possible in seven cases. The larynx and the pharynx (16 percent each) were the most common sites of affection. Incidence peaks were noted in the third and seventh decade of age. Treatment during the 1950s consisted of surgery and/or irradiation and was supplemented from the 1960s on by polychemotherapy. The median survival was 29 months. Three patients are alive, two patients died free of disease and six patients were lost to follow-up. CONCLUSION: Permanent cure was rare but each therapeutic regimen seemed to provide prolongation of life. The most important prognostic factors were tumor size, histologic grade, and surgical margins.

Cathepsin D and PAI-1 expression in human head and neck cancer.

In order to determine possible overexpression of cathepsin D and PAI-1 (plasminogen activator inhibitor) in head and neck tumours, cytosols from 92 primary squamous cell carcinomas (SCC), 19 lymph node metastases and 24 adjacent normal tissue samples were examined. For both cathepsin D and PAI-1, significantly elevated concentrations in SCC compared to normal tissue were found, even in pairwise comparison. Moreover, significantly higher cathepsin D and PAI-1 concentration in lymph node metastases than in corresponding normal tissue were also present. The conclusion was drawn that cathepsin D and PAI-1 may play a specific role in the biology of head and neck SCC.