Immunohistochemical and molecular-pathological diagnosis of myocarditis in cases of suspected sudden infant death syndrome (SIDS)--a multicenter study.

Virus-induced myocarditis is a common disease even in infants and children, but diagnosis can be difficult according to the Dallas-criteria, which have been criticised as being too unreliable. The diagnosis has been substantially improved due to immunohistochemical techniques for characterization and quantification of myocardial inflammatory reactions as well as molecular-pathological methods for viral genome detection. The published studies report on post-mortem samples from SIDS victims and controls which were prospectively investigated. Pediatric cases of unnatural deaths served as controls. The results demonstrate a clearly higher prevalence of viral myocardial infections in cases of suspected SIDS. Preliminary criteria for cellular immunohistochemical diagnosis of viral myocardial affections derived from these findings were suggested.

Feasibility report for retreatment of locally recurrent head-and-neck cancers by combined brachy-chemotherapy using frameless image-guided 3D interstitial brachytherapy.

PURPOSE: Brachytherapy re-irradiation may offer an alternative re-treatment of recurrent head-and-neck cancer even after previous full dose radiation therapy. The purposes of this study were to determine the feasibility and accuracy of frameless image-guided interstitial needle implantation. METHODS AND MATERIALS: Between January 2000 and March 2003, 14 patients with biopsy-proven locally recurrent head-and-neck-cancer were retreated after previous full dose irradiation with combined external beam-brachytherapy with concomitant chemotherapy. Brachytherapy needle implantation was virtually planned taking into account the surrounding risk structures. Needles were implanted using an adapted frameless navigation system. Chemoradiotherapy was followed by 2-4 courses of chemotherapy every fourth week starting 4 weeks after the end of brachytherapy. RESULTS: The 1- and 2-year local control rates were 78% and 57%, respectively. Local control was obtained in 8/14 patients. The actuarial 1- and 2-year survival rates were 83% and 64%, respectively. The median survival was 28 months after a median follow-up of 21 months (range, 8-53). Six weeks after brachytherapy, 1 patient developed localized soft tissue necrosis which did not require surgical intervention. No additional grade III or IV late toxicity was seen after re-irradiation. Mean deviation of image-guided needle implantation was 3.4 mm for each needle (SD, 1.9 mm; range, 0.5-14 mm). The mean deviation of all needles of an implant was 4.3 mm (range, 2.3-8.6 mm). CONCLUSIONS: These data demonstrate that pulsed-dose-rate brachytherapy in combination with sequential chemotherapy is effective and safe in re-irradiation of locally recurrent oropharyngeal carcinomas and can be offered to patients with curative intent. Image guidance allows virtual planning and navigated implantation of brachytherapy needles with regard to optimized needle distribution and risk structures.

Role of virus-induced myocardial affections in sudden infant death syndrome: a prospective postmortem study.

The cause of sudden infant death syndrome (SIDS) is an unresolved problem of high relevance. Previous studies indicate a role of infections. In our prospective study, we investigated the frequency of virus-induced myocardial affections in SIDS. Postmortem samples from SIDS victims and control subjects were investigated prospectively. Pediatric cases of unnatural death served as controls. Samples were studied for enteroviruses, adenoviruses, parvovirus B19, and Epstein-Barr virus applying PCR. Immunohistochemical investigations for inflammatory cells, the necrosis marker C5b-9((m)) complement complex, and the enteroviral capsid protein VP1 were performed. Overall, 62 SIDS victims were studied. As controls, 11 infants were enrolled. Enteroviruses were detected in 14 (22.5%), adenoviruses in 2 (3.2%), Epstein-Barr viruses in 3 (4.8%), and parvovirus B19 in 7 (11.2%) cases of SIDS. Control group samples were completely virus negative. Compared with controls, immunohistochemical investigations partially revealed a significant increase in the number of T lymphocytes in SIDS myocardial samples (p < 0.05). Furthermore, cases with elevated numbers of leukocytes and macrophages, microfocal C5b-9((m))(+) necroses, and enteroviral VP1 capsid protein within the myocardium were detected. Applying a comprehensive combination of molecular and immunohistochemical techniques, our results demonstrate a clearly higher prevalence of viral myocardial affections in SIDS. Our results emphasize the importance of PCR-based diagnosis of viral myocardial affections. We suggest preliminary criteria for cellular immunohistochemical diagnosis of viral myocardial affections derived from our findings. For future investigations in SIDS, we suggest a comprehensive approach that includes PCR and immunohistochemistry. Our results offer novel strategies for diagnosis of pediatric myocardial viral affections.

Maxillofacial fractures resulting from falls.

OBJECTIVE: This study was performed to clarify the characteristics of facial fractures caused by falls with a particular focus on aetiology. PATIENTS: Of 505 patients with facial fractures treated in the Department of Oral and Maxillofacial/Craniofacial Surgery, Heidelberg University Hospital from January 1997 to May 2001, 129 patients injured by falls were analysed. STUDY DESIGN: Aetiological analysis was performed according to falling patterns. RESULTS: The distribution of age showed two peaks in the 4th and 8th decades, and the male to female ratio was 1.1:1, unlike the overall facial fracture ratio of 3:1. Seventy-six patients had fallen from standing height or less and 44 patients had fallen from greater heights. The former cases were more often seen in older females. More severe injuries tend to be seen in the patients who have fallen from greater heights, and in the cases associated with acute medical disorders. CONCLUSION: This retrospective study documents the higher risk of fractures in older females and the higher risk of severe injury in those patients who were unconscious. This is in agreement with recent orthopaedic studies.

Coxsackie B3 myocarditis in 4 cases of suspected sudden infant death syndrome: diagnosis by immunohistochemical and molecular-pathologic investigations.

Immunohistochemical and molecular-pathologic techniques have improved the diagnosis of myocarditis as compared with conventional histologic staining methods done according to the Dallas criteria. Most investigations were carried out on adults, and only a few authors investigating childhood deaths applied these modern methods, used for diagnosing myocarditis. We report on four children under one year of age, who suddenly died without prodromal symptoms. Their deaths were attributed to SIDS (sudden infant death syndrome). Immunohistochemical (LCA, CD68, CD45R0, MHC-class-II-molecules, VP1-capsid-protein of enteroviruses) and molecular-pathologic (RT-PCR) investigations, however, suggested that death was caused by a coxsackie-B3-myocarditis. In the future, these methods should be used for investigating cases with suspicion of SIDS.