Laryngo-esophageal dysfunction free survival and propensity score matched analysis comparing organ preservation and total laryngectomy in hypopharynx cancer.

AIMS: To assess the functional outcomes of patients treated for hypopharynx cancer and to obtain an unbiased estimate of survival difference between patients treated with chemoradiotherapy (CRT) or total laryngectomy (TL). METHODS: Retrospective cohort study of all patients treated with curative intent for T1-T4 squamous cell carcinoma of the hypopharynx in The Netherlands Cancer Institute (1990-2013). Functional outcome following radiotherapy (RT) or CRT was measured using laryngo-esophageal dysfunction free survival rate (LDFS). Using propensity score (PS) matched analysis, we compared survival outcome of TL to CRT in T2-T4 patients. RESULTS: We included 343 patients with T1T4 hypopharynx cancer. LDFS 2 and 5-years following CRT was respectively 44 and 32%. Following RT this was 39 and 30%. Patients were matched on the following variables: age, gender, TNM classification, subsite of tumor, decade of diagnosis, prior cancer, smoking, ACE27 score, BMI hemoglobin, albumin, and leukocyte level. With PS matching, we were able to match 26 TL patients with 26 CRT patients. The OS rates for TL and CRT in this matched cohort were respectively 56% and 46% at 5 years and 35% and 17% at 10 years. CONCLUSION: In conclusion, functional outcomes following RT or CRT are suboptimal and require improved treatment strategies or rehabilitation efforts. The OS results challenge the preposition that CRT and TLE are equivalent in terms of survival.

[Diphenylhydantoin, epilepsy, cerebellar atrophy--histological and electron microscope examinations (author's transl)]. / Diphenylhydantoin, Epilepsie, Kleinhirnatrophie--Histologische und elektronenmikroskopische Untersuchungen.

Neuropathological investigations of CNS of two epileptic patients (a man and a woman), who had been treated over years with diphenylhydantoin, disclosed in both cases severe cerebellar atrophy, with almost complete loss of Purkinje cells. Hypoxic tissue alterations were found neither in cerebellum nor in cerebrum. Ultrastructural examination of formalin fixed tissue revealed in cytoplasm of degenerating Purkinje cells multilamellar structures similar to those reported by other authors, presumably consisting of proliferated cisternae of endoplasmic reticulum, degenerating mitochondria and "multilamellar cytoplasmic bodies". However, these findings are very probably not specific; they were detected also in Purkinje cells of a non-epileptic patient of the same age-group, suddenly deceased by car accident. Reversible cerebellar dysfunction is a common manifestation of acute phenytoin toxicity. However, further factors can influence the action of DPH, leading to chronic intoxication and irreversible cerebellar damage. A review of these factors is given. The periodic monitoring of serum DPH-concentration is emphasized.

[Investigation in patients with central serous retinopathy with the MMPI Saarbrücken (author's transl)]. / Untersuchung zur Objektivierung von Persönlichkeitsmerkmalen bei Patienten mit Retinopathia centralis serosa.

Patients with angiographically proven C.S.R. were investigated with the MMPI. They showed significantly higher scores on the hypochondria and hysteria-scale. The idea, that C.S.R. is an ocular psychosomatic disease is supported by the profile pattern, which shows an elevation of the "Neurotic Triad" with the characteristically depressed "Psychosomatic Valley".