ABSTRACT
We report the case of a 6-year-old patient with suspected recurrence of a plunging ranula in clinical and ultrasonographic examination. Surgical resection of the left submandibular and sublingual glands had already been performed. Since persistent glandular tissue could not be excluded with certainty via MRI, we expanded diagnostics by performing a PET/MRI using a head and neck imaging protocol and the radiotracer 18F-PSMA-1007, which is physiologically expressed by salivary gland tissue. The 18F-PSMA-PET/MRI provided evidence of a cystically transformed, diminishing seroma in the left retro-/submandibular region. No 18F-PSMA expressing glandular tissue could be detected in the area of resection, excluding a relapse of a plunging ranula. As a consequence, we opted for a conservative treatment without further surgical intervention. We conclude that a simultaneous 18F-PSMA-PET/MRI is a comprehensive imaging modality, which can help to rule out persistent salivary tissue and recurring plunging ranula. It is a useful tool to facilitate the decision making of surgical interventions.
ABSTRACT
According to the active systems consolidation theory, memories undergo reactivation during sleep that can give rise to qualitative changes of the representations. These changes may generate new knowledge such as gaining insight into solutions for problem solving. targeted memory reactivation (TMR) uses learning-associated cues, such as sounds or odors, which have been shown to improve memory consolidation when re-applied during sleep. Here we tested whether TMR during slow wave sleep (SWS) and/or rapid eye movement (REM) sleep increases problem solving. Young healthy volunteers participated in one of two experiments. Experiment 1 tested the effect of natural sleep on problem solving. Subjects were trained in a video game-based problem solving task until being presented with a non-solved challenge. Followed by a ~10-h incubation interval filled with nocturnal sleep or daytime wakefulness, subjects were tested on the problem solving challenge again. Experiment 2 tested the effect of TMR on problem solving, with subjects receiving auditory TMR either during SWS (SWSstim), REM sleep (REMstim), or wakefulness (Wakestim). In Experiment 1, sleep improved problem solving, with 62% of subjects from the Sleep group solving the problem compared to 24% of the Wake group. Subjects with higher amounts of SWS in the Sleep group had a higher chance to solve the problem. In Experiment 2, TMR did not change the sleep effect on problem solving: 56 and 58% of subjects from the SWSstim and REMstim groups solved the problem compared to 57% from the Wakestim group. These findings indicate that sleep, and particularly SWS, facilitates problem solving, whereas this effect is not further increased by TMR.
ABSTRACT
OBJECTIVES: This study investigated benefits of routine panendoscopy in staging of oral squamous cell cancer patients. MATERIALS AND METHODS: From 2013 to 2017, 194 oral squamous cell cancer patients were staged. Reports of routine flexible panendoscopy including oropharyngolaryngoscopy, bronchoscopy, and esophagogastroduodenoscopy were retrospectively analyzed for diagnoses of inflammation and second primary malignancies (carcinoma in situ or cancer) and compared to results of computed tomography. The effects of alcohol and tobacco history of 142 patients were assessed. RESULTS: Overall, a second primary malignancy was detected in seven patients. In four patients this discovery was only found by panendoscopy. One invasive carcinoma (esophagus) was detected as well as three carcinoma in situ. The second primary malignancies were located in the lung (3), esophagus (3), and stomach (1). In one patient index tumor therapy was modified after panendoscopy. Upper gastrointestinal inflammation was present in 73.2% of patients and 61.9% required treatment. About 91.8% of bronchoscopies and 34.5% of panendoscopies were without therapeutic consequences. Patients with higher risk from smoking were more likely to benefit from panendoscopy and to have a Helicobacter pylori infection. CONCLUSION: We do not recommend routine panendoscopy for all oral squamous cell cancer patients. Esophagogastroduodenoscopy benefitted smoking patients primarily concerning the secondary diagnosis of inflammation of the upper digestive tract. Selective bronchoscopy, esophagogastroduodenoscopy, and oropharyngolaryngoscopy should be performed if clinical examination or medical history indicates risks for additional malignancies of the upper aerodigestive tract. CLINICAL RELEVANCE: Routine panendoscopy is not recommended in all, especially not in low-risk oral cancer patients like non-smokers and non-drinkers.
