Feeding and swallowing outcomes following mandibular distraction osteogenesis: an analysis of 22 non-isolated paediatric cases.

Patients with mandibular hypoplasia and upper airway obstruction are at an increased risk of feeding and swallowing difficulties. Little has been described regarding these outcomes following mandibular distraction. The aim of this study was to evaluate the effect of mandibular distraction on feeding and swallowing function. A retrospective study was performed on 22 patients with non-isolated mandibular hypoplasia and severe upper airway obstruction treated with mandibular distraction. Median age at first mandibular distraction was 3.1 years (interquartile range 2.3-6.0 years) and the median follow-up time was 3.5 years (interquartile range 2.0-9.4 years). Prior to mandibular distraction, feeding difficulties were present in 18 patients. Swallowing difficulties were present in 20 patients, all of whom had problems in the oral phase of swallowing, while 11 patients had additional problems in the pharyngeal phase. Following mandibular distraction, at the time of follow-up, feeding difficulties persisted in 13 patients. Swallowing difficulties in the oral phase remained present in all 20 patients, while pharyngeal phase problems persisted in seven patients. In conclusion, feeding and swallowing difficulties are highly prevalent in non-isolated patients and often persist following mandibular distraction. Moreover, these can be the reason that decannulation cannot be accomplished. Hence, awareness and close follow-up by a specialized speech therapist is of paramount importance.

Functional outcomes in patients with facial dysostosis and severe upper airway obstruction.

An increased risk of upper airway obstruction (UAO) is seen in up to 95% of patients with facial dysostosis. Secondary to respiratory problems are feeding difficulties and increased nutritional requirements. Little has been described regarding these outcomes in this patient population. Hence, a retrospective cohort study was performed to gather data on functional outcomes. Eighteen patients with facial dysostosis and severe UAO were included. The median follow-up time was 3.42 years. A tracheostomy tube was placed in 13 patients, of whom 10 subsequently underwent mandibular distraction. Three of the five patients without a tracheostomy underwent mandibular distraction as the primary surgical treatment; the remaining two patients were treated conservatively with oxygen supplementation. At presentation, 13 patients had feeding difficulties. Overall malnutrition was present in 16 patients during follow-up. At the end of follow-up, severe UAO was present in 12 patients, feeding difficulties in seven patients, and malnutrition in four patients, while two patients died. In conclusion, patients with facial dysostosis have a high prevalence of severe UAO, feeding difficulties, and malnutrition. Importantly, mandibular distraction has limited success in treating severe UAO in these patients. Close follow-up by a specialized craniofacial team is of paramount importance to manage the long-term consequences.

A higher protein intake at breakfast and lunch is associated with a higher total daily protein intake in older adults: a post-hoc cross-sectional analysis of four randomised controlled trials.

BACKGROUND: A protein intake of 30-40 g per meal is suggested to maximally stimulate muscle protein synthesis in older adults and could therefore contribute to the prevention of sarcopenia. Protein intake at breakfast and lunch is often low and offers a great opportunity to improve daily protein intake. Protein, however, is known for its satiating effects. Therefore, we explored the association between the amount of protein intake at breakfast and lunch and total daily protein intake in older adults. METHODS: Protein intake was assessed by a 3-day food record in 498 community dwelling older adults (≥55 years) participating different lifestyle interventions. Linear mixed model analysis was used to examine the association between protein intake at breakfast or lunch and total daily protein intake, adjusted for sex, age, body mass index, smoking status, study and total energy intake. RESULTS: After adjustment for potential confounders, a 10 g higher protein intake at breakfast was associated with a 3.2 g higher total daily protein intake (P = 0.008) for males and a 4.9 g (P < 0.001) higher total daily protein intake for females. A 10 g higher protein intake at lunch was associated with a 3.7 g higher total daily protein intake (P < 0.001) for males, and a 5.8 g higher total daily protein intake (P < 0.001) for females. CONCLUSIONS: A higher protein intake at breakfast and lunch is associated with a higher total daily protein intake in community dwelling older adults. Stimulating a higher protein intake at breakfast and lunch might represent a promising nutritional strategy to optimise the amount of protein per meal without compromising total daily protein intake.

Nutrient-rich foods, cardiovascular diseases and all-cause mortality: the Rotterdam study.

BACKGROUND/OBJECTIVES: The nutrient-rich food (NRF) index assesses nutrient quality of individual food items by ranking them according to their nutrient composition. The index reflects the nutrient density of the overall diet. We examined the associations between the NRF9.3 index-a score on the basis of nine beneficial nutrients (protein, fiber, vitamins and minerals) and three nutrients to limit (saturated fat, sugar and sodium)-incidence of cardiovascular disease (CVD) events and all-cause mortality. SUBJECTS/METHODS: A total of 4969 persons aged 55 and older from the Rotterdam Study, a prospective cohort study in the Netherlands, were studied. First, all foods were scored on the basis of their nutrient composition, resulting in an NRF9.3 score on food item level. Subsequently, they were converted into individual weighted scores on the basis of the amount of calories of each food item consumed by the subjects and the total energy intake. The hazard ratios (HRs) of the NRF9.3 index score were adjusted for age, gender, body mass index, smoking history, doctor-prescribed diet, alcohol consumption and education. RESULTS: Food groups that contributed most to the NRF9.3 index score were vegetables, milk and milk products, fruit, bread and potatoes. A high NRF9.3 index score was inversely associated with all-cause mortality (HR Q4 versus Q1: 0.84 (95% confidence interval: 0.74, 0.96)). Associations were stronger in women than in men. The NRF9.3 index score was not associated with incidence of CVD. CONCLUSION: Elderly with a higher NRF9.3 index score, indicating more beneficial components and/or less limiting components, had a lower risk of all-cause mortality. Consuming a nutrient-dense diet may improve survival.

New advances in the pathogenesis and progression of barrett's esophagus.

Barrett's esophagus (BE) is a premalignant condition in the esophagus, with a rising incidence rate among Caucasians, and an established risk factor for the subsequent progression to esophageal adenocarcinoma (EAC). In contrast to the stratified squamous epithelium that normally lines the distal esophagus, BE is characterized by columnar epithelium that to some extent resembles the mucosa of the lower intestinal tract. The mechanism of intestinalization of the esophagus is still uncertain. For many years, it was postulated that either abnormal differentiation of resident progenitor cells in the esophagus, or transdifferentiation of mature esophageal keratinocytes provoked by reflux-induced genetic alterations, resulted in the BE phenotype. However, more recent studies suggest that indigenous progenitor cells at the gastro-esophageal junction might, under unfavorable conditions such as TP63 loss or an activated inflammatory response, migrate to the esophagus and initiate columnar cell differentiation. In this review, we discuss the competing theories of the origins of BE, as well as the role of developmental signaling pathways such as Notch, Hedgehog, and Wnt/ß-catenin signaling that have been implicated in the molecular pathogenesis of BE and EAC. Additionally, we provide an overview of the mutational landscapes of BE and EAC, derived from the results of recently published next generation sequencing (NGS) studies. Future research should elucidate whether NGS on endoscopic mucosal biopsies can help in identifying BE patients at highest risk for EAC development, and whether some of the prevalent mutations are "actionable", leading to improvements in current therapeutic strategies for BE and EAC.

Next-generation sequencing of endoscopic biopsies identifies ARID1A as a tumor-suppressor gene in Barrett's esophagus.

The incidence of Barrett's esophagus (BE)-associated esophageal adenocarcinoma (EAC) is increasing. Next-generation sequencing (NGS) provides an unprecedented opportunity to uncover genomic alterations during BE pathogenesis and progression to EAC, but treatment-naive surgical specimens are scarce. The objective of this study was to establish the feasibility of using widely available endoscopic mucosal biopsies for successful NGS, using samples obtained from a BE 'progressor'. Paired-end whole-genome NGS was performed on the Illumina platform using libraries generated from mucosal biopsies of normal squamous epithelium (NSE), BE and EAC obtained from a patient who progressed to adenocarcinoma during endoscopic surveillance. Selective validation studies, including Sanger sequencing, immunohistochemistry and functional assays, were performed to confirm the NGS findings. NGS identified somatic nonsense mutations of AT-rich interactive domain 1A (SWI like) (ARID1A) and PPIE and an additional 37 missense mutations in BE and/or EAC, which were confirmed by Sanger sequencing. ARID1A mutations were detected in 15% (3/20) high-grade dysplasia (HGD)/EAC patients. Immunohistochemistry performed on an independent archival cohort demonstrated ARID1A protein loss in 0% (0/76), 4.9% (2/40), 14.3% (4/28), 16.0% (8/50) and 12.2% (12/98) of NSE, BE, low-grade dysplasia, HGD and EAC tissues, respectively, and was inversely associated with nuclear p53 accumulation (P=0.028). Enhanced cell growth, proliferation and invasion were observed on ARID1A knockdown in EAC cells. In addition, genes downstream of ARID1A that potentially contribute to the ARID1A knockdown phenotype were identified. Our studies establish the feasibility of using mucosal biopsies for NGS, which should enable the comparative analysis of larger 'progressor' versus 'non-progressor' cohorts. Further, we identify ARID1A as a novel tumor-suppressor gene in BE pathogenesis, reiterating the importance of aberrant chromatin in the metaplasia-dysplasia sequence.

Squamous cell carcinoma in Barrett's esophagus: field effect versus metastasis.

Barrett's esophagus (BE) is a premalignant condition with an increased risk of developing esophageal adenocarcinoma (EAC). Risk factors for EAC overlap with those for esophageal squamous cell carcinoma (ESCC), but ESCC is surprisingly rare in BE. We report two cases of ESCC directly surrounded by BE. Both patients had a previous medical history of cancers, i.e., head and neck squamous cell carcinomas, and were using alcohol and smoking tobacco. Using immunohistochemistry for p63, CK5, CK7, and CDX2, it was confirmed that these carcinomas were pure squamous cell carcinomas, and not EACs or esophageal adenosquamous carcinomas arising from BE. Using TP53 mutation and loss of heterozygosity analysis, we established that the ESCCs in BE were not metastases of the previously diagnosed head and neck squamous cell carcinomas but de novo primary ESCCs. This study shows the strength of molecular analysis as an adjunct to the histopathologic diagnosis for distinguishing between metastases of prior cancers and primary cancers. Furthermore, these cases imply that presence of BE is not protective with regards to developing ESCC in the lower one third of the esophagus. We suggest that their ESCCs arose from islets of squamous epithelium in BE.

[The impact of a university ENT emergency centre for the ambulatory care of ENT emergency patients]. / Stellenwert der Notfallambulanz einer Universitäts-HNO-Klinik für die ambulante Patienten-Versorgung.

BACKGROUND: The impact of a German University ENT emergency unit has not been investigated yet. The present study had the aim to define the role of such an ENT emergency unit for the medical supply of ENT emergency cases. Patients' characteristics, diagnostics and therapeutical processes have been analysed. METHODS: In a retrospective study 3 695 emergency cases of the year 2004 have been characterized. RESULTS: Patients referring to the ENT emergency unit are relative young with an average age of 36 years. 72% are coming from the urban area. Two thirds referred themselves without seeing another physician before. The spectrum of diagnoses was broad, mainly similar to the normal spectrum of diseases seen in daily outpatient practice. 17% were emergency cases in narrower sense needing direct help because of real threat. 25% of the patients needed more than a clinical ENT examination. 9% of the cases were admitted to the hospital. DISCUSSION: In a major city without specialised outpatient ENT emergency system patient are attracted regularly to present at the University ENT emergency unit. This means a significant work load for the resident on duty. Most of the patients have ENT diseases treatable with this one and last patient contact. On the other hand, the hospital recruits an important amount of patients for inpatient treatment through the emergency unit.

Age is an independent risk factor for left atrial dysfunction: results from an observational study.

Introduction. The degenerative changes of myocardial tissue are thought to influence left atrial (LA) function. Changes of left atrial function are generally due to changes in left ventricle (LV) compliance. But valvular dysfunction and hypertension as comorbidity cannot be ignored. Women have a different clinical profile compared with men concerning the risk of heart failure. We investigated the influence of increasing age and gender corrected for comorbidity, on left atrial function.Methods. Using an open access echocardiography database, supplemented with additional LA function measurements, we defined three different LA function parameters. Odds ratios (OR) were calculated to reproduce the relation between age, gender and LA function. The association between age, gender and LA function was estimated, and corrected for comorbid conditions as valve disease, high blood pressure and LV dysfunction, using logistic regression.Results. Higher age was positively correlated with increased LA volume, decreased ejection fraction and increased LA kinetic energy. Age per decade increase, corrected for comorbidity, resulted in an increased risk of LA dysfunction (OR between 1.5 and 1.9). Gender had little influence on LA function parameters except for LA maximal volume. Men had a significantly larger LA maximal volume compared with women. Conclusions. In this open access echocardiography database, increasing age was correlated with LA dysfunction. Age per decade increase, corrected for comorbid conditions such as mitral and aortic valve disease, hypertension and heart failure, is an independent risk factor for LA dysfunction. The gender influence on LA dysfunction seems to be limited. (Neth Heart J 2010;18:243-7.).

[Problematic medical expertise concerning simulation and aggravation in audiology]. / Zur Problematik der Simulation und Aggravation in der HNO-ärztlichen Begutachtung.

BACKGROUND: The effect of an incorrect audiological medical assessment of noise trauma deafness can be substantial. The impact will be demonstrated using a case example. The reasons for incorrect assessment are often insufficient examination conditions or simulation and aggression of the subject. The results of a study on this topic will be presented. PATIENTS AND METHODS: A total of 61 patients who underwent a psycho-acoustic medical assessment were grouped into 1 of 4 categories ranging from category 0 for no simulation or aggravation to category III for severe simulation and aggravation. For category III reliable and valid thresholds of pure tone audiometry can only be achieved using objective audiological measurements. The frequency, extent and socio-economic factors were evaluated. RESULTS: Of the 61 individuals 26 showed no simulation or aggravation behavior (category 0), 10% were grouped into category III and 48% into categories I and II. The tendency to simulation and aggravation increased with the patients' age, the level of education and the frequency of medical examinations prior to this investigation. CONCLUSIONS: Simulation and aggravation is a more frequent phenomenon than previously assumed (approximately 58% of all audiological examinations). The effect in terms of economical damage could be substantial. The usage of a well-defined classification is highly recommended in order to improve the quality of medical assessment in ENT.

Long-term wine consumption is related to cardiovascular mortality and life expectancy independently of moderate alcohol intake: the Zutphen Study.

BACKGROUND: Light to moderate alcohol intake lowers the risk of cardiovascular mortality, but whether this protective effect can be attributed to a specific type of beverage remains unclear. Moreover, little is known about the effects of long-term alcohol intake on life expectancy. METHODS: The impact of long-term alcohol intake and types of alcoholic beverages consumed on cardiovascular mortality and life expectancy at age 50 was investigated in the Zutphen Study, a cohort of 1373 men born between 1900 and 1920 and examined repeatedly between 1960 and 2000. Hazard ratios (HRs) for total alcohol intake and alcohol from wine, beer and spirits were obtained from time-dependent Cox regression models. Life expectancy at age 50 was calculated from areas under survival curves. RESULTS: Long-term light alcohol intake, that is < or =20 g per day, compared with no alcohol, was strongly and inversely associated with cerebrovascular (HR 0.43, 95% CI 0.26 to 0.70), total cardiovascular (HR 0.70, 95% CI 0.55 to 0.89) and all-cause mortality (HR 0.75, 95% CI 0.63 to 0.91). Independent of total alcohol intake, long-term wine consumption of, on average, less than half a glass per day was strongly and inversely associated with coronary heart disease (HR 0.61, 95% CI 0.41 to 0.89), total cardiovascular (HR 0.68, 95% CI 0.53 to 0.86) and all-cause mortality (HR 0.73, 95% CI 0.62 to 0.87). These results could not be explained by differences in socioeconomic status. Life expectancy was about 5 years longer in men who consumed wine compared with those who did not use alcoholic beverages. CONCLUSION: Long-term light alcohol intake lowered cardiovascular and all-cause mortality risk and increased life expectancy. Light wine consumption was associated with 5 years longer life expectancy; however, more studies are needed to verify this result.

Carcinoma ex pleomorphic adenoma of the parotid gland. Study and implications for diagnostics and therapy.

BACKGROUND: Carcinoma ex pleomorphic adenoma (CXPA) is a rare parotid malignancy and until today no standardized concept exists for its therapy apart from recommendations for parotid carcinoma in general. Prognosis is thought to be poorer than for other parotid malignancies. We sought to describe a general diagnostic and therapy strategy and assess factors predicting the outcome. METHODS: We retrospectively analysed the courses of 22 patients with a CXPA of the parotid gland treated at a tertiary medical care centre for otorhinolaryngology. We examined parameters of medical history, diagnostics, surgical and adjunctive therapy and analysed overall and disease-specific survival. RESULTS: About half of the patients had evidence of a parotid mass of up to 1 year only while maximum of the others was 48 years. Nine patients were primarily operated without suspicion for malignancy. Both 5-year disease-specific and overall survival were 60%. Recurrence-free survival rate after 5 years was 85%. Any patients with a stage I or II disease had an uneventful follow-up. To date, no patient with a stage IV disease has survived longer than 5 years. CONCLUSION: Surgical therapy (total or radical parotidectomy) is the method of choice for CXPA of the parotid gland. Stage I tumors have a very good and stage IV tumors a bad prognosis.

[Piriform sinus fistula resulting in acute dyspnea in a newborn]. / Sinus-piriformis-Fistel als seltene Ursache von Dyspnoe bei einem Neugeborenen.

Piriform sinus fistulas are rare congenital deformities that may become symptomatic through cyst enlargement and inflammation. The fistula usually manifests as bacterial thyroiditis and is very uncommonly seen as a cause of acute dyspnea in newborns. We report the case of a newborn in whom a piriform sinus fistula led to acute breathing impairment. If the piriform sinus fistula and adherent cyst cannot be totally removed initially, the treatment must be followed later by a complete resection to prevent infection.

[Multiple primary pleomorphic adenomas of the unilateral parotid gland]. / Das unilaterale, primär multilokuläre pleomorphe Adenom der Ohrspeicheldrüse.

BACKGROUND: Classical lateral parotidectomy is the standard surgical procedure for the management of lateral lobe parotid pleomorphic adenomas in most clinical centres. Extracapsular dissection and subtotal lateral parotidectomy are alternatively discussed in current literature and preferred by many authors. CASE: We report on a 20-year-old patient with multiple primary pleomorphic adenomas in the unilateral parotid gland, which preoperatively presented as a solitary tumour node. CONCLUSION: Considering this case we focus on the distinctive surgical procedures for the management of parotid pleomorphic adenomas. We work out, why lateral or even total parotidectomy are justified in the treatment of solitary palpable tumours and why we account lateral parotidectomy as the standard surgical procedure for the management of lateral lobe parotid pleomorphic adenomas.

[Simulation and aggravation in ENT medical examinations. A prospective study]. / Simulation und Aggravation in der HNO-ärztlichen Begutachtung. Eine prospektive Untersuchung.

OBJECTIVE: The occurrence and characteristics of simulation and aggravation in audiology still lack detailed scientific research. A reliable and reasonable classification of simulation and aggravation, which could help assess a patient's cooperative behavior, has not been defined. PATIENTS AND METHODOLOGY: All patients who underwent an audiological medical examination were included in this study prospectively. These patients were examined based on a well structured and predetermined sequence of actions. As a result, they were grouped into one of four categories, from category 0 for no simulation or aggravation to category III for severe simulation and aggravation. For category III, reliable and valid thresholds for pure tone audiometry only can be achieved by using objective audiological measurements such as brainstem electric response audiometry. Measured thresholds were then compared with simulated or aggravated thresholds and finally correlated with socio-economic factors. RESULTS: A total of 61 individuals were included in this study. Only 42% (26/61) showed no simulation or aggravation (category 0). In all 10% were grouped in category III. The remaining 48% fell into categories I and II. Statistical evaluation revealed no significant differences in thresholds between categories I, II and III. The tendency to simulation or aggravation increased with patient' age, level of education and the frequency of medical examinations prior to this investigation. CONCLUSION: Simulation and aggravation is a frequent phenomenon (approximately 58% of all audiological examinations). Additional work on defining a unique schema for the classification of simulation and aggravation is necessary. The use of such a schema is highly recommended.

Blood pressure response to calcium supplementation: a meta-analysis of randomized controlled trials.

Calcium plays a role in blood pressure (BP) regulation, but the importance of supplemental calcium intake for the prevention of hypertension is still debated. We conducted a meta-analysis of randomized controlled trials to determine the effect of calcium supplementation on BP. A systematic search for randomized trials of calcium supplementation and BP in non-pregnant subjects was performed in Medline from 1966 to June 2003. Seventy-one trials were identified, 40 of which met the criteria for meta-analysis (total of 2492 subjects). Two persons independently extracted data from original publications on changes in calcium intake and BP. In addition, data were collected on subjects' characteristics, that is, age, gender, initial BP and initial calcium intake. A random effects model was used to obtain the effect of calcium supplementation on BP, overall and in predefined population subgroups. Calcium supplementation (mean daily dose: 1200 mg) reduced systolic BP by -1.86 mm Hg (95% confidence interval: -2.91 to -0.81) and diastolic BP by -0.99 mm Hg (-1.61 to -0.37). In people with a relatively low calcium intake (< or =800 mg per day) somewhat larger BP estimates were obtained, that is, -2.63 (-4.03 to -1.24) for systolic BP and -1.30 (-2.13 to -0.47) for diastolic BP. Our study suggests that an adequate intake of calcium should be recommended for the prevention of hypertension. More research on BP in people with calcium-deficient diets is warranted.

Axonal branching and recovery of coordinated muscle activity after transection of the facial nerve in adult rats.

Facial nerve surgery inevitablyleads to pareses, abnormally associated movements, and pathologically altered reflexes. The reason for this "post-paralytic syndrome" is the misdirected reinnervation of targets, which consists of two major components. First, due to malfunctioning axonal guidance, a muscle gets reinnervated by a "foreign" axon, that has been misrouted along a "wrong" fascicle. Second, the supernumerary collateral branches emerging from all transected axons simultaneously innervate antagonistic muscles and cause severe impairment of coordinated activity. Since it is hardly possible to influence the first major component and improve the guidance of several thousands of axons, we concentrated on the second major component and tried to reduce the collateral axonal branching. The efficiency of various treatments was evaluated in rats by determining: (1) the degree of post-operative axonal branching as estimated by the number of double-or triple-labeled perikarya after application of crystalline DiI, Fluoro-Gold (FG), and Fast Blue (FB) to the zygomatic, buccal, and marginal mandibular branch of the facial nerve respectively; (2) the accuracy of reinnervation as estimated by the number of double-labeled perikarya innervating the whisker pad muscles before and after surgery as shown by intramuscular injections of FG and FB respectively; (3) the recovery of vibrissal motor performance, estimated by a video based motion analysis. So far, we have tried to reduce branching by alteration of the afferent trigeminal input to the axotomized facial motoneurons and by focal application of: (1) neurite outgrowth fostering ECM proteins; (2) neutralizing antibodies to NGF, BDNF, CNTF, GDNF, IGF-I, and FGF-II; (3) suspensions of olfactory ensheathing cells, Schwann cells, and bone marrow stroma cells; and (4) pieces of autologous olfactory mucosa to the transection site. Although most of these manipulations do influence peripheral nerve regeneration to some extent, only the application of autologous olfactory mucosa yielded a major improvement, i.e., better function.

Motoneuron adaptability to new motor tasks following two types of facial-facial anastomosis in cats.

The ability of the facial motor system to adapt to a new motor function was studied in alert cats after unilateral transection, 180 degrees rotation and suture of the zygomatic nerve, or transection and cross-anastomosis of the proximal stump of the buccal nerve to the distal stump of the zygomatic nerve. These procedures induced reinnervation of the orbicularis oculi (OO) muscle by different OO- or mouth-related facial motoneurons. Eyelid movements and the electromyographic activity of the OO muscle were recorded up to 1 year following the two types of anastomosis. Animals with a zygomatic nerve rotation recovered spontaneous and reflex responses, but with evident deficits in eyelid kinematics, i.e. the proper regional distribution of OO motor units was disorganized by zygomatic nerve rotation and resuture, producing a permanent defect in eyelid motor performance. Following buccal-zygomatic anastomosis, the electrical activity of the OO muscle was recovered after 6-7 weeks, but air puff-, flash- and tone-evoked reflex blinks never reached the control values on the operated side. Electromyographic OO activities and lid movements corresponding to licking and deglutition activities were observed on the operated side in buccal-zygomatic anastomosed animals up to 1 year following surgery. Mouth-related facial motoneurons did not readapt their discharges to the kinetic, timing and oscillatory properties of OO muscle fibres. A significant hyper-reflexia was observed following both types of nerve repair in response to air puffs, but not to light flashes or tones. In conclusion, adult mammal facial premotor circuits maintain their motor programmes when motoneurons are induced to reinnervate a foreign muscle, or even a new set of muscle fibres.

[Perioperative mortality in otorhinolaryngology tumor surgery]. / Perioperative Mortalität in der HNO-Tumorchirurgie.

BACKGROUND: Perioperative mortality is an important factor for quality assurance in surgery. For ENT-surgery only sparse data has been published. PATIENTS AND METHODS: A retrospective analysis of 1054 interventions performed on 775 consecutive patients treated surgically for benign and malignant tumors of the head and neck was conducted during a 3-year period in 1995-1998. RESULTS: Of these patients, 34.1% were female and 65.9% male. Age ranged from 4-88 years with a mean age of 54.8 years. 489 patients (63.1%) were treated for malignoma and 286 for benign tumors (36.9%). 0.9% (n = 7) of our patients (n = 775) died during the first 30 days after surgery. That means 0.66% of all surgical interventions (n = 1054) were followed by post-operative mortality. DISCUSSION: In otorhinolaryngological surgery, post-operative mortality seems to be acceptable and low compared to other medical disciplines. The challenge for surgery must be to reach and preserve low perioperative mortality rates in the future. Finding the individually correct indication for surgical treatment must be guaranteed in order to reach this aim.

[Quality assurance indicators in an ENT practice]. / Qualitätsbewertende Indikatoren in einer HNO-Klinik.

BACKGROUND: According to German legislature, hospitals have to implement quality assurance (QA) programs, which are of particular importance in times of ongoing structural changes in healthcare. Amongst other internal methods of QA, indicators measuring the quality of total hospital performance can reflect medical outcome and the activities of physicians, nurses, and administrators. METHODS: Five indicators for measuring total hospital performance and for controlling total medical outcome were used in this study. RESULTS: Evaluation was time consuming, and some indicators showed a wide range, which could be explained by external reasons independent from internal quality. Valid values could be ascertained in the field of administrative quality, whereas in contrast the assessment of medical quality seemed to be more difficult. CONCLUSION: Due to current developments in German healthcare, the application of quality assurance methods such as the presented system of indicators is recommended.