[Ultrasound investigation of cervical lymph node metastases: conception and results of a histopathological exploration]. / Ultraschalluntersuchung zervikaler Lymphknotenmetastasen: Konzept und Ergebnis einer histopathologischen Aufarbeitung.

BACKGROUND: Ultrasound (US) is one of the most important methods for detection of cervical lymph node metastases in malignancies of the head and neck. In our study, the specificity of ultrasound was explored by a special, histopathological exploration considering the anatomical regions of the neck. METHODS: Thirty-eight patients were studied (5 female, 33 male, age: 38-86 years) with different histology and incidence of metastatic spread of head and neck cancers. Forty-six neck dissections were performed (30 radical and 16 selective). Histological exploration was performed after pinning the neck soft tissue with needles to anatomical live drawings of the lymph node regions, a modification of the Medina procedure. This procedure allowed a correct topographical assignment of lymph node metastases and comparison of preoperative sonographical findings with histopathological results. RESULTS: We isolated 1333 lymph nodes, 137 of them infiltrated by metastases. These lymph node metastases were found in 28 of 46 neck dissections. The number of lymph nodes in radical neck dissections ranged from 21 to 60 (mean: 36), in selective neck dissection from 1 to 43 (mean: 16). Sensitivity, specificity, and accuracy of ultrasound reached 96%, 69%, and 78%, respectively. Seventy-two lymph node metastases (52%) of 12 neck dissections could not be evaluated by ultrasound. CONCLUSIONS: Our results confirm the reliability of ultrasound regarding sensitivity, specificity and accuracy of US-detectable cervical lymph nodes as reported in world literature. However, we were able to demonstrate in special histopathological explorations, that ultrasound did not detect more than 50% of present lymph node metastases in our series. We consider it essential to perform histopathological explorations of the soft tissue of the neck as described in our study to evaluate the efficacy and reliability of US, CT, and MRI in detecting lymph node metastases of head and neck malignancies.

Pretherapeutic scalene lymph node biopsy in ovarian cancer.

To study scalene lymph node involvement in ovarian cancer, 37 patients with this disease underwent pretherapeutic open sampling of the left scalene fat tissue. Only 1 patient had a palpable supraclavicular mass. Positive scalene nodes were found in 7 (22%) of 32 patients with stage III or IV disease. Three of four patients with positive scalene nodes also had both positive pelvic and positive paraaortic nodes; one patient with stage IV disease had negative pelvic and paraaortic nodes. Demonstration of scalene node involvement per se currently does not alter the management of patients with ovarian cancer, although patients with occult involvement of the scalene nodes could be considered ineligible for intraperitoneal chemotherapy.

MR-imaging with Gd-DTPA in carcinomas of tongue, oro- and hypopharynx.

High-field MRI was performed in a series of 24 patients with squamous cell carcinomas of the tongue, oro- and hypopharynx. The value of contrast enhanced T1-weighted images in tumor staging was established prospectively. Non-contrast T1-weighted images did not provide sufficient tumor-delineation. Marked contrast enhancement produced by Gd-DTPA was observed in all carcinomas and in normal pharyngeal mucosa. In tumors of the tongue and upper pharynx clinical examination and ultrasound were equally sensitive as post-contrast MRI; in tumors of the lower pharynx the true tumor extension could be better assessed by contrast-enhanced MRI.

[Scalenus biopsy in diagnosis of ovarian and uterine cancers]. / Die Skalenusbiopsie in der Diagnostik von Ovarial- und Uteruskarzinomen.

Patients with tumours of the lower pelvis were submitted to a biopsy of the scalene fat pad. The primary tumour was a carcinoma of the ovary in 32, of the cervix in 4, and of the body of the uterus in 2 cases. Microscopic metastases in the pre-scalene lymph nodes were found in 7 of the 32 cases of ovarian carcinoma (21.8%), but in none of the patients with carcinoma of the uterus. Since a histologically positive finding of a scalene lymph node influences the treatment, biopsy of the scalene fat pad is recommended as part of the pre-operative investigation of patients with ovarian carcinoma.

[Differential diagnosis of ulcerative mucous membrane diseases of the mouth cavity and pharynx]. / Zur Differentialdiagnose ulzeröser Schleimhauterkrankungen der Mundhöhle und des Pharynx.

Nonmalignant ulcerous diseases of the mouth often require repeated histological and clinical observations for several weeks to establish a diagnosis. One patient with Wegener's disease, one with a necrotizing sialometaplasia, and a case of Sutton-type aphthosis outline these difficulties. In all three cases, only a synopsis of histology, laboratory findings, and clinical appearance led to the respective diagnosis.

Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique.

The Messerklinger technique is a primarily diagnostic endoscopic concept demonstrating that the frontal and the maxillary sinuses are subordinate cavities. Disease usually starts in the nose and spreads through the ethmoidal prechambers to the frontal and maxillary sinuses, with infections of these latter sinuses thus usually being of secondary nature. Standard rhinoscopy and sinus X-rays are frequently not sufficient to demonstrate the underlying causes for chronic or recurring acute sinusitis in the clefts of the anterior ethmoidal sinuses. The combination of diagnostic endoscopy of the lateral nasal wall with conventional or computed tomography in the coronal plane has proven to be the ideal method for the examination of inflammatory disease of the paranasal sinuses. In so doing, diseases and lesions that otherwise might have gone undiagnosed can be identified and consequently treated. Based on this diagnostic approach, an endoscopic surgical concept was developed, aiming for the underlying causes of sinus diseases instead of the secondarily involved larger sinuses. With usually very limited surgical procedures, diseased ethmoid compartments are operated on, stenotic clefts widened and prechambers to the frontal and maxillary sinuses freed from disease. In our experience, there is rarely a need for major manipulations inside the larger sinuses per se. Based on exact diagnosis, the surgical technique used allows a very individualized staging according to the prevailing pathology. In the extreme, a total sphenoethmoidectomy can be performed with this technique, although the true advantage of the technique is that even in cases of massive disease such radical procedures can be avoided. By reestablishing sinus ventilation and drainage via the natural ostia, there is also no need for fenestration of the inferior meatus. The Messerklinger technique can be applied to a wide spectrum of indications, apart from nasal polyposis. The technique has its clear limits as well as its specific problems. Adequate training and experience are required for the surgical approach, as the technique bears all the risks and hazards of all kinds of endonasal ethmoid surgery but has a minimal complication rate in the hands of an experienced surgeon. Results and complications of a series of more than 4500 patients over a period of over 10 years are presented and discussed in detail.