Endoscopic negative pressure therapy (ENPT) of a post-laryngectomy pharyngocutaneous fistula: first report of a new treatment method.

In the current first report, it is shown how a post-laryngectomy pharyngocutaneous fistula was successfully closed by endoscopic negative pressure therapy (ENPT; also termed endoscopic vacuum therapy, EVT). The duration of negative pressure treatment was 14 days. Up until now, ENPT has been used for treatment of transmural defects in the rectum and esophagus. The new endoscopic method can also be used in the ENT field for closure of pharyngocutaneous fistulas.

[Endoscopic negative pressure therapy of a post-laryngectomy pharyngocutaneous fistula-first report of a new therapeutic method. German version]. / Endoskopische Unterdrucktherapie einer pharyngokutanen Fistel nach Laryngektomie ­ Erstbeschreibung eines neuen Therapieverfahrens.

In the current first report, it is shown how a post-laryngectomy pharyngocutaneous fistula was successfully closed by endoscopic negative pressure therapy (ENPT; also termed endoscopic vacuum therapy, EVT). The duration of negative pressure treatment was 14 days. Up until now, ENPT has been used for treatment of transmural defects in the rectum and esophagus. The new endoscopic method can also be used in the ENT field for closure of pharyngocutaneous fistulas.

Efficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis - a randomised, double-blind, placebo-controlled study with adaptive design and interim analysis.

OBJECTIVE: This randomised, double-blind, parallel group phase II/III study with adaptive two-stage design and interim analysis compared the efficacy and tolerability of spray (containing a Salvia officinalis fluid extract) against placebo in the treatment of patients with acute viral pharyngitis. - STUDY PARTICIPANTS: in two study parts, a total of 286 patients with subjective and objective evidence of pharyngitis were randomized. In the first study part 122 patients were enrolled. In the second study part 164 patients were included. The treatment duration per patient was 3 days, including one baseline visit and one final visit. - MAIN OUTCOME MEASURES: Area under Curve for change of throat pain intensity (spontaneous pain), documented every 15 minutes within the first 2 hours after the first application as compared to baseline using a visual analog scale (VAS 100 mm). - RESULTS: Following the interim analyses of the first study part the 15 % spray containing 140 microl sage extract per dose was the most promising preparation for the second study part (main study) whereas for the 30% and the 5% preparation results made superiority over placebo unlikely in the final analysis. Overall, the 15 % spray was significantly superior to placebo for the primary efficacy variable with regard to a reduction of the throat pain intensity score. Only minor side effects such as dry pharynx or burning of mild intensity were seen. - CONCLUSIONS: The efficacy and tolerability profile of a 15 % sage spray indicated that this preparation provides a convenient and safe treatment for patients with acute pharyngitis. A symptomatic relief occurred within the first two hours after first administration and was statistically significantly superior to placebo.

[Is the observation of patients with sleep-apnea-syndrome after surgery of the upper airway in an intensive care unit generally necessary?]. / Ist die postoperative Uberwachung von Patienten mit schlafassoziierten Atemstörungen nach Nasenoperationen auf einer Intensivstation erforderlich?

BACKGROUND: Although it is known that after surgery of the nose and/or the paranasal sinuses serious complications can arise for patients suffering from Sleep-Apnea-Syndrome (SAS), there exists no general recommendation for postoperative care of these patients. This retrospective analysis is dealing with the question whether it is generally necessary to observe SAS-patients after nasal surgery including intubation in an Intensive Care Unit (ICU). PATIENTS AND METHODS: 24 Patients of the ORL-Dept., Marienkrankenhaus Hamburg, suffering from SAS underwent surgery of the nose, the paranasal sinuses and/or the pharynx including total intravenous anesthesia (TIVA) during the period of 1. 10. 2000 until 1. 5. 2004. SAS was diagnosed in 6 cases due to defined clinical criteria and in 18 cases due to the polysomnographic findings in the sleeping laboratory's examination. All patients were observed postoperatively for one night in an ICU. The anesthesia protocol and the intensive care curve of each patient were systematically evaluated with special regard of the following parameters: Risk factors (Body Mass Index; other diseases, ASA-classification), premedication drugs, duration of the surgery, drugs for pain relief, lowest O2-saturation of blood, lowest heartrate, highest systolic blood pressure, adverse effects, intensive care interventions. RESULTS: Intensive care interventions were never needed. 2 patients received a low dosage of oxygeninsufflation via a face mask, in 5 cases calcium-antagonist drugs were administered due to high blood pressure and in 1 case Metamizole administration was necessary due to high temperatures. An accompanying bradycardia of the same patient was treated by administration of Atropine. The lower average O2-saturation was 93.6 +/- 1.7 % (Minimum value: 89 %). The maximum systolic blood pressure was 165.8 +/- 21.2 mm Hg and the lowest average heart rate was 65.4 +/- 13.2 bpm. CONCLUSIONS: Patients suffering from a mild to moderate SAS do not need a general postoperative surveillance in an ICU if the chosen form of anesthesia is considered concerning this sickness.

[Sodium selenite reduces acute radiogenic damage of the rat parotid glands during fractionated irradiation]. / Reduktion akuter radiogener Schädigungen durch Natriumselenit. Wirksamkeit unter fraktionierter Bestrahlung der Glandula parotis der Ratte.

BACKGROUND: In vitro studies show that sodium selenite is a potential radioprotector in normal cell cultures, but not tumor cells. The aim of this study was to evaluate the cytoprotective potency of sodium selenite during conventional fractionated irradiation of rat salivary glands, but also on tumor response and metastasis frequency of rhabdomyosarcomas R1H. METHOD: The head-neck area of male WAG/RijH rats and the tumor in the flank were irradiated with (60)Co-gamma-rays (60 Gy/30 fractions/6 weeks). Sodium selenite (15 microg/kg body weight) was applied through a venous port 30 min before irradiation. Rats of a control group were treated in the same manner with an equal volume of physiologic sodium chloride. In the course of treatment the salivary glands were extirpated at different stages and examined histopathologically. The evaluation of the gland function was performed prior to and after radiotherapy by sialoscintigraphy. Tumor volume was measured during irradiation and plotted in tumor-volume curves. Rat body weight was determined sequentially to estimate the general constitution of the animal during the treatment. RESULTS: Irradiation caused dose-dependent damage in the salivary glands. Intra- and intercellular edema (16 Gy), vacuolization (30 Gy), degranulation (46 Gy), and necrosis of the acinar cells (60 Gy) occurred. Sodium selenite delayed the development of the described damage, and the amount of necrotic acinar cells after the application of 60 Gy was reduced (control: 75% vs sodium selenite 30%), confirmed by the sialoscintigraphic results. The loss in gland function in the control group was 44% vs 74% (p<0.05) in the sodium selenite group. Sodium selenite had no influence on the response of R1H tumors to radiation and general constitution. CONCLUSIONS: Based on morphological and sialoscintigraphic findings, a cytoprotective effect on acute toxicity of rat salivary glands could be detected under irradiation with synchronous application of sodium selenite. In addition, no effects on tumor response and metastasis frequency were observed. The general animal constitution was not affected by additional medication with sodium selenite during irradiation.

[Course and therapy of an invasive aspergilloma of the skull base in a non-immunocompromised patient]. / Sinugene Schädelbasisaspergillose. Verlauf und Therapie bei einem immunkompetenten Patienten.

Fulminant-invasive sinus aspergillosis affects immunocompromised patients and is usually lethal because of intracranial complications. Chronic-invasive and non-invasive types occur in non-immunocompromised patients. In these cases, intracranial extension is possible and life-threatening. The effective management of sinus aspergillosis requires early diagnosis by CT and histological classification, surgery, and if necessary, chemotherapy or steroids in case of allergy. Here we report a successfully treated case in a 29-year-old non-immunocompromised patient with chronic-invasive sinus aspergillosis. He presented a recurrent sphenoid sinus aspergillosis with destruction of the clivus and ophthalmoplegia. Diagnostic and therapeutic procedures are described.

[Retrospective analysis of the prognostic significance of depth of invasion of advanced oral and oropharyngeal squamous cell carcinomas with lymph node metastases]. / Prognostischer Einfluss der Infiltrationstiefe von Mundhöhlen- und Oropharynxkarzinomen. Retrospektive Analyse bei fortgeschrittenen Tumoren mit N+ -Hals.

BACKGROUND: The often documented prognostic influence of the depth of invasion of oral and and oropharyngeal squamous cell carcinomas should be examined using more advanced lymphogenic metastasized tumours. This should be compared with the established prognostic factors T stage and capsular rupture of the lymph node metastases. METHODS: Five-year postoperative follow-ups of 66 patients treated consecutively were studied retrospectively. RESULTS: There was no significant relationship for the depth of invasion of the primary tumour. Survival rate was significantly related only to the T stage. CONCLUSION: In the presence of lymph node metastases and in particular of capsular rupture, T stage and depth of tumour invasion lose their prognostic value. The prognostic value of features of the primary tumor such as size and depth of invasion is limited to early non-metastasized oral and and oropharyngeal squamous cell carcinomas.

Course and therapy of intoxication with imidazoline derivate naphazoline.

OBJECTIVE: Imidazoline derivatives like naphazoline have a firm place in diagnostics and therapy of otorhinolaryngology because of their vasoconstrictive and decongestive properties. Their alpha-adrenergic potential could induce not only local but also systemic side effects like hypertension and tachycardia which can increase a life-threatening intoxication. Signs of imidazoline intoxication are excessive systolic and diastolic hypertension and hypotension, bradycardia with arrhythmia, respiratory depression, excitation or severe CNS depression. PATIENTS: The typical course of an intoxication and its sufficient therapy is reported by means of two cases of intraoperative application of naphazoline for hemostasis. RESULTS: In case of overdosage or intoxication, symptomatic drug therapy with intravenous administration of 5 mg phentolamine for adults and 1 mg phentolamine for infants has to be done. Phentolamine, an alpha-adrenoceptor antagonist, acting against peripheral and central side effects has to be used because no specific antidote is available. CONCLUSIONS: Especially pediatric otorhinolaryngologists have to know about symptoms and therapy of an intoxication after application of naphazoline. Particularly with children, a narrow therapeutic to toxic window can be observed in this frequently used drug.

[Reconstruction of the frontal sinus with a calvarium split galea periosteum transplant after inflammatory complications]. / Rekonstruktion der Stirnhöhle mit einem Calvarian-split-Galea-Periost-Transplantat nach entzündlichen Komplikationen.

After reconstruction of the frontal sinus with alloplastic material, with or without obliteration of the lumen, inflammatory complications may occur. The authors present a plastic-surgical functional reconstruction technique for revision surgery in cases of inflammatory complications following frontal sinus implantation of alloplastic material, by means of a modified autologous calvarian split graft. The inflammatory complications after primary reconstruction or obliteration of the frontal sinus occurred after a period of 1-10 years. The previously implanted material was removed from the frontal sinus and the anterior wall was reconstructed with a combined calvarian split/galea periost-transplant. During follow-up, which ranged from 1-5 years, no further inflammatory complications occurred. Furthermore, an appealing cosmetic result was achieved in all cases. We conclude that the functional and aesthetic result depends primarily on (1) embedding and protection of the graft by an additional covering with a galea-periost-flap, and (2) reconstruction of the frontal drainage pathways.

[Life-threatening complications after plastic tracheostomy closure. Which length of hospital stay according to clinical and forensic viewpoints is necessary?]. / Lebensbedrohende Komplikationen nach plastischem Tracheostomaverschluss. Welche stationäre Aufenthaltsdauer ist aus klinischer und forensischer Sicht erforderlich?

BACKGROUND: Plastic tracheostomy closure represents a safe surgical method with rare but potentially life-threatening complications such as dyspnea. Because of the general tendency to reduce hospital stay, the medically necessary time of hospitalization should be evaluated. METHODS: Ninety-eight patients operated in succession were examined retrospectively for extent, time, and therapeutic procedures in cases of life-threatening dyspnea. Moreover, disorders of wound healing which had to be treated surgically were analyzed. RESULTS: Of 98 patients 17% (17/98) developed dyspneas, 10% (10/98) up to the 3rd postoperative day, 2% (2/98) on the 6th postoperative day, and 5% (5/98) between the 17th and 92nd postoperative days; 13% (13/98) had to be treated because of extensive disorders of wound healing, 85% (11/13) up to the 3rd day. CONCLUSION: From the clinical and forensic viewpoint, a hospital stay for at least 3 postoperative days is necessary to record the majority of life-threatening complications after plastic tracheostomy closure.

The prognostic impact of metastatic pattern of lymph nodes in patients with oral and oropharyngeal squamous cell carcinomas.

In patients with squamous cell carcinomas of the oral cavity and the oropharynx the presence or absence of nodal metastases still is the most important predictive factor. The discriminative significance of extracapsular spread and the influence of features of the primary tumor-such as size and depth of invasion-on metastatic pattern, treatment failure and survival were evaluated. Five-year postoperative follow-ups of 115 consecutively treated patients were studied retrospectively concerning the incidence of distant metastases, local and regional recurrences and the 5-year survival rate. Maximum depth of invasion of the primary tumor and lymph node metastases were evaluated on the basis of histological patterns, and patients were grouped according to their histological diagnosis. The T4 category has a plain discriminative influence on the incidence of distant metastases, recurrent tumors and survival rate in contrast to the other T sizes. The classification N0, intranodal growth and extranodal growth of lymph node metastases resulted in a 5-year survival rate of 67, 59 and 31%. According to the classification, 84, 87 and 59% were without nodal recurrence after 5 years, and 79, 82 and 46% without distant metastases. Size and depth of invasion of the primary tumor are not connected significantly with the occurrence of extracapsular spread. The status of the lymph nodes in squamous cell carcinomas of the oral cavity and the oropharynx metastases and in particular the capsular rupture has the most significant prognostic influence. The histological feature of extracapsular spread could distinguish reproducibly high risk patients with squamous cell carcinomas of the oral cavity and the oropharynx.

[Capsular rupture of lymph node metastases as most significant prognostic factor in head and neck squamous cell carcinomas--Hamburg experiences]. / Die Kapselruptur metastatisch befallener Lymphknoten als entscheidendes prognostisches Kriterium bei Karzinomen des oberen Aerodigestivtraktes--Hamburger Erfahrungen.

BACKGROUND: TNM classification of squamous cell carcinomas of the head and neck contains only size and number of the lymph node metastases. The histological criterion of capsular rupture and its prognostic significance was assessed by an exact histological scheme of capsular rupture and extracapsular spread of the metastasis and was compared with N0 or lymph node metastases without capsular rupture respectively. METHODS: Incidences of distant metastases, tumor recurrences, and survival of 194 consecutive patients with squamous cell carcinomas of the head and neck were investigated. Lymph node metastases were examined by the gradual histological scheme and patients were rated according their histological diagnosis. RESULTS: The classification N0/intranodal tumor growth/extranodal tumor growth resulted in a 5-year survival rate of 74%/62%/25%. According to the classification 67%/72%/37% of the patients were without local recurrent tumor and without distant metastases were 81%/79%/48% after 5 years. CONCLUSIONS: Capsular rupture seems to contain more decisive prognostic value as the criterion of only lymphatic metastatic disease. The histological scheme allows an exact assessment of the capsular rupture or the metastatic pattern of the lymph node. Because of its prognostic significance and individual therapeutic consequences the easily reproducible criterion of capsular rupture is a useful completion to current TNM classification.

[The valence of dilatational tracheotomy]. / Zur Wertigkeit der Dilatationstracheotomie.

After standardizing surgical procedures around 1900 Shelden, Toye, Weinstein and Ciaglia developed the percutaneous dilational tracheotomy (PDT). At present it is recognized that about 50 % of the anesthesiological Intensive care Units (ICU) in Germany are using the PDT while favoring the Ciaglia-technique in the majority of cases. Further techniques are known as Griggs-, Fantoni-, Percu-Twist- and Blue-Rhino-method. Some of these are relatively new, therefore making critical comparison with other methods almost impossible due to lack of experience. The most feared complications of PDT are injury of the cricoid cartilage or of the rear tracheal wall as well as paratracheal positioning of a tracheotomy tube. Comparison between PDT and surgical techniques are difficult due to certain contraindications for PDT which are not valid for surgical procedures. Consecutively PDT will not be able to substitute surgical tracheotomy in the future. It furthermore can't be advocated as an alternative therapeutic option for mobile in-patients outside the ICU.

[Universal newborn hearing screening in Marien Hospital Hamburg from September 1999 till April 2002]. / Universelles Neugeborenen-Hörscreening im Marienkrankenhaus Hamburg von September 1999 bis April 2002.

BACKGROUND: With a prevalence of 5 in 1000 newborns with a hearing disorder, the congenital hearing disorders apparently constitute a serious health problem. The aim of this study was the introduction of a universal newborn hearing screening at our clinic. We also investigated if a universal screening only on parents' demand is possible. METHODS: From September 1999 to April 2002 a total of 3049 newborns, delivered at the Marien Hospital in Hamburg 97 %, were screened with the Echo-Screen TE (Fischer-Zoth). RESULTS: Only 2 of the 3049 screened infants showed signs of severe sensori-neural hearing loss. Both children belonged to high risk groups. During the period of the parental request for an investigation only 10.4 % of the newborn were screened compared to 97 % newborns during the universal newborn hearing screening. CONCLUSION: By measurement of TEOAE alone, we found a significantly lower incidence of hearing disorders than reported in literature; it may therefore not be sufficient for screening. Universal newborn hearing screening only performed on parents' demand seems to be impossible to conduct. Also before establishing a universal newborn hearing screening, cost allocation has to be solved.

[Therapy of iatrogenic pharyngocutaneous fistulas--possibilities of surgical treatment]. / Die postoperative Pharynxfistel--Möglichkeiten eines operativen Therapiekonzeptes.

BACKGROUND: During tumor surgery of the upper respiratory and digestive tract, pharyngocutaneuos fistulas may occur postoperatively. Predisposing factors are tissue disorders, as can be seen after radiation therapy or wound infections. The aim of this study was to create a systematic approach to the treatment of such complications. METHODS: Patient charts of oncologic patients with postoperative salivary fistulas were analysed retrospectively. According to the surgical technique used for treating these fistulas, a systematic strategy for the therapeutic management of this complication has been created. RESULTS: Out of 212 operatively treated tumor patients with pharyngeal reconstruction, 23 developed pharyngocutaneous fistulas. A significant higher incidence could be observed in patients with wound healing disorders or after radiotherapy. The recurrence rate of salivary fistulas has shown to be comparably high when only single layer muscular flaps were used. The lowest rate of recurrence could be observed after pharyngeal reconstruction using myocutaneous flaps. In only 7 % of our cases, a microvascular anastomosis was possible, due to the vascular status. In 85 % of our cases, additional fasciocutaneous flaps had to be integrated for complete wound closure. This became necessary mainly because of necrosis and dehiscence. In 3 cases of severe wound healing disorders with recurrent fistulas, additional therapeutic options such as hyperbaric oxygen therapy lead to complete remission. CONCLUSION: For the definitive treatment of postoperative salivary fistulas, especially in patients with wound healing disorders, a concept of therapeutic options using myocutaneous flaps in combination with fasciocutaneous flaps, depending on the location, is necessary.

[Comparison between transoral microsurgery by CO2 laser and conventional surgical therapy for T2 glottic carcinoma]. / Vergleichende Untersuchung zwischen Lasertherapie und konventionell chirurgischer Therapie des T2-Glottiskarzinoms.

BACKGROUND: Transoral CO2 laser excision of early glottic cancer was first introduced in the 1970s. Since then it has become a serious alternative to surgery with conventional instruments. PATIENTS AND METHODS: Between January 1987 and December 1997, 46 patients with T2 N0 M0 glottic carcinoma have been treated by either transoral laser microsurgery or fronto-lateral partial laryngeal resection with curative intention. Long-term results of both methods were compared after analysation of tumor-localization and recurrence-rate. Evaluation parameters were: incidence of local recurrence and incidence of death due to local recurrence. Other aspects of investigation were hospitalisation-time and treatment related patient morbidity. RESULTS: Analysis of the data of our study shows that local recurrences were 5 % lower in cases of laser surgical tumor resection as opposed to conventional surgery (11 % vs. 16 %). If evaluated in accordance to localization of local recurrence in combination with primary tumor localization, results show that all three recurrent tumors in the group of laser resected patients had a primary in the anterior glottic area; two out of the three recurrences following fronto-lateral laryngeal resection were localized in the mid-third of the vocal cord. Hospital-admittance in laser-resected patients was shorter by one day when compared with the group of conventional surgery (10 vs. 11 days). CONCLUSION: T2-Tumors of the anterior glottic area should preferably be approached by conventional surgery (external approach), particularly when endoscopical visualization is difficult. In contrast, T2-tumors of the medial and posterior glottic area should be resected endolaryngeally with the laser.

[Advance in therapy of acute rhinitis--comparison of efficacy and safety of xylometazoline in combination xylometazoline-dexpanthenol in patients with acute rhinitis]. / Fortschritt in der Therapie der akuten Rhinitis. Vergleich der Wirksamkeit und Unbedenklichkeit von Xylometazolin mit der Kombination von Xylometazolin-Dexpanthenol bei Patienten mit akuter Rhinitis.

BACKGROUND: Acute Rhinitis is based on an inflammation of the nasal mucous membrane with nasal discharge and obstruction. Symptomatic treatment includes local application of decongestants as Xylometazoline and epithelia-protective agents as Dexpanthenol. After proving a synergistic effect of Xylometazoline and Dexpanthenol (Nasic) in patients after nasal surgery, this result should be checked in patients with acute non-allergic rhinitis. PATIENTS AND METHODS: Randomised verum controlled double-blind parallel-group-comparison of five days treatment with nasal sprays containing the combination of Xylometazolin-Dexpanthenol or Xylometazolin. MAIN OUTCOME MEASURE: The assessments of nasal obstruction, rhinorrhea, hyperplasia of nasal concha and redness of the nasal mucous membrane were defined as main-target parameters. RESULTS: 152 outpatients diagnosed with non-allergic, acute rhinitis were included in this study. 151 patients completed the study according to protocol. The superiority of the treatment with Xylometazolin-Dexpanthenol could be proven for the main outcome measures in comparison to Xylometazolin clinically relevant and statistically significant. The result was also validated by the secondary endpoints. The clinically proven efficacy is emphasized by the rhinoscopic findings and safety parameters showing a better tolerability of the combination. CONCLUSION: Accelerating the wound healing corroborates the superiority of the combination and is due to the epithelia protective effect of Dexpanthenol. These results allow especially under socio-economic points of view the conclusion that shorter treatment time with a diminishing risk of a "rebound effect" will improve compliance.

[Naphazoline intoxication: course and therapy]. / Die Intoxikation mit Naphazolinnitrat (Privin): Verlauf und Therapie.

BACKGROUND: As potent alpha-adrenergic agonists imidazoline derivatives like naphazoline are frequently used drugs because of their vasoconstrictive and decongestant properties. Beside their well-known local side effects also rare systemic ones like hypertension, excitability and nausea are possible. In case of intoxication this can enhance to ischemia of vital organs, bradycardia with arrhythmia, respiratory depression, hypothermia, excitation or marked sedation. PATIENTS: Two cases of intoxication after application of naphazoline for haemostasis under the operation, the postoperative course and therapy are reported. RESULTS: No specific antidote is available but a symptomatic drug therapy with intravenous administration of 5 mg phentolamine, an alpha-adrenoceptor antagonist acts against the vasoconstrictive side effects. CONCLUSIONS: Because of the serious side effects and the narrow therapeutic to toxic window of naphazoline a strict observance of guidelines and contradictions, such as maximum dose, is necessary.

[Cutaneous malignant melanoma of the head and neck with intermediate tumor thickness: the role of elective lymph node dissection for clinical stage I]. / Kutane maligne Melanome der Kopf-Hals-Region mit intermediärer Tumordicke: die Bedeutung der elektiven Versorgung der Lymphabflusswege im klinischen Stadium I.

BACKGROUND: At present a tendency towards a more limited surgery in the treatment of clinical stage I and II melanoma exists. The controversy of elective lymph node dissections (ELND) in stage-I-melanoma with intermediate tumor thickness continues to be discussed. The sentinel lymph node biopsy may provide improved staging accuracy. METHODS: It was the aim of this study to examine whether extent of surgical treatment particularly the ELND in case of intermediate tumor thickness has prognostic significance. Metastatic pattern of these malignant melanoma were analyzed to form a basic for routine sentinel lymph node biopsy. RESULTS: No prognostic difference could be shown in clinical stage I melanoma with intermediate tumor thickness between "local excision" (no lymph node dissection) or "wait and see" (delayed lymph node dissection because of clinical suspicion) respectively and "local excision with elective neck dissection". The 5-year survival was 67 %, 67 % and 69 %. It ran to 53 % in case of therapeutical lymph node dissection as primary therapy. Occult nodal metastases occur in 15 % and "skip"-metastases in 6 %. CONCLUSIONS: No therapeutic value for ELND in clinical stage I malignant melanoma of the head and neck with intermediate tumor thickness could be shown. The low incidence of occult nodal metastases and "skip"-metastases represents the basic for sentinel lymph node biopsy.

[Reducing late toxicity with amifostine in fractionated irradiation of the rat salivary glands]. / Reduktion der Spättoxizität durch Amifostin bei fraktionierter Bestrahlung der Rattenspeicheldrüsen.

Clinical studies show that amifostine can reduce xerostomia and mucositis during radiotherapy of head and neck cancers. The aim of this study was to evaluate the radioprotective potency of amifostine with respect to late toxicity of salivary glands of rats. The head-neck-area of 8 male WAG/RijH rats (295 +/- 7 g) were irradiated with 60Co-gamma-rays (60 Gy/30 f/6 weeks). Amifostine (250 mg/m2 body surface) was applied via a venous port 15 min before each irradiation. Rats of a control group were irradiated with the same schedule with equal volumes of physiological saline. The morphological and sialoscintigraphical findings clearly demonstrate that amifostine has a remarkable cytoprotective effect on the late toxicity of irradiated salivary glands.