Foreign body aspiration in children: field report of a German hospital.

BACKGROUND: The aspiration of foreign bodies (FB), especially by small children, is a life-threatening situation and can be fatal. The aim of this survey was to study the types of foreign bodies in the upper airways and digestive tract, and the circumstances leading to the aspiration on the basis of hospital records of the Berlin University Hospital in Germany from 1997-2002. METHODS: We performed a retrospective review of hospital records using a standardized protocol. Foreign body aspiration that occurred in children aged 0-14 were considered for inclusion in the database. During the study period, 78 patients with a diagnosis of FB were included in the database. Forty-five patients were male and 33 were female. The median age was 1. RESULTS: In 89.5% of all cases, the children were under the age of 3. Seventy-five of the 78 patients had a foreign body in the trachea/bronchial trees/lungs based on International Classification of Diseases-9 codes at the time of discharge. At the time the injury occurred, the children had either been eating (41.1%) or playing (50.0%). More than 50% of the children were being supervised by an adult at the time the injury occurred. The foreign bodies (FB) were always extracted by using an endoscopic procedure (n= 43 rigid, n= 6 flexible and n= 29 combination of both methods). Moreover, hospitalization was always required due to an institutional requirement. The most commonly found foreign bodies were seeds, nuts, berries and grains. CONCLUSION: Most of the foreign bodies were found in the bronchial tubes, trachea, and lungs. The extraction method from these areas is rigid and/or flexible bronchoscopy or gastrointestinal endoscopy, a procedure requiring anesthesia. There seems to be no association between the aspirated foreign bodies and other purchased objects or packaging material. The fact that a large fraction of the injuries occur under the supervision of the adults suggests that the number and severity of the injuries could be reduced by educating parents and children. Our experience confirms, therefore, that further research into the behavioral aspects leading to FB injuries is needed.

Apoptosis, necrosis and hypoxia inducible factor-1 in human head and neck squamous cell carcinoma cultures.

The objective of this study was to examine the mode of cell death and the hypoxia inducible factor-1 (HIF-1) expression of human head and neck squamous cell carcinoma (HNSCC) exposed to hypoxia in vitro. Apoptosis and necrosis rates were examined using flow cytometry. The findings suggest that HNSCC cells show a considerable heterogeneity in cell size and in response to hypoxia. A small-cell population showed a high spontaneous apoptosis and necrosis rate which was in-sensitive to hypoxia. A large-cell population responded to hypoxia by increase of apoptosis rate in parallel to recruitment of HIF-1. Hypoxia led to increased HIF-1alpha protein levels in nuclear extract using ELISA-binding activity. In all cells, accumulation of HIF-1 in the nuclei during hypoxia and a rapid degradation of HIF-1 in the post-hypoxic period were observed immunocytochemically. The HIF-1alpha mRNA level showed an expression of 10-40 pg/microg total RNA and remained unchanged in one cell line, while slightly decreasing in the other. Remarkably, no increased luciferase activity response was found on the reporter gene level using pGL3 reporter gene with three erythropoietin hypoxia responsive elements, either by hypoxia or by application of lactacystin, desferrioxamine or CoCl2. These findings suggest that, in HNSCC cells, hypoxia induces HIF-1alpha to stabilize and accumulate in the cell nuclei but have a cell-specific transcriptional complex.

Association of cyclin D1 polymorphism with increased susceptibility to oral squamous cell carcinoma.

We have examined the association of the CCND1 A/G870 polymorphism with susceptibility and outcome in 174 German patients with oral SCC (OSCC). The CCND1 G870 allele frequency was increased in cases (G870=0.65) when compared to controls (n=155, G870=0.54) and the distribution of CCND1 genotypes were significantly different (p=0.014). Using logistic regression, correcting for age, gender and tobacco consumption, an increased frequency of the CCND1 GG870 genotype was observed in the OSCC cases (p=0.025, OR 3.37, 95% CI 1.61-9.80). No significant associations were observed between CCND1 A/G870 and tumour histological factors. Our data suggests that the CCND1 GG870 genotype is associated with increased susceptibility to OSCC. The involvement of cyclin D1 polymorphism in mechanisms of SCC development may differ in the different sub-sites of the head and neck.

Neurofibroma in the mastoid segment of the facial canal.

Neural tissue-derived facial nerve tumours usually present as neurinomas. We describe the extremely rare occurrence of a histologically verified neurofibroma primarily arising in the mastoid segment of the facial canal in a patient not fulfilling diagnostic criteria for neurofibromatosis. The tumour showed evidence of perineural growth into the jugular foramen, as suggested by cross-sectional imaging and intraoperative findings.