[The value of chest CT-scanning for staging of progressed or recurrent head and neck squamous cell carcinomas (HNSCC)]. / Die Wertigkeit der Computertomographie des Thorax im Rahmen des Stagings von fortgeschrittenen Kopf-Hals-Malignomen.

AIM: At time of diagnosis, up to 17 % of HNSCC present with distant metastasis or a second primary tumour. Distant metastases of these tumours most commonly occur in the lung, requiring a particularly precise evaluation of this organ within the staging process. It was the aim of this study to compare the radiological findings of plain chest X-rays with the results of CT-scans of the chest in regard to their sensitivity for metastasis detection. PATIENTS AND METHODS: The staging examinations of 47 patients (f: 13, m: 34, mean age: 61.6 y) with progressed (T3, T4, N+) or recurrent HNSCC were prospectively analysed and results of chest X-rays as well as CT-scans of the chest compared. RESULTS: Only one plain chest X-ray showed a possible metastasis, which was excluded by the following CT-scan. In none of the other 46 patients did X-ray reveal findings of metastatic disease or second primary tumours. CT-scans of the chest showed tumorous lesions in 8/47 (17 %) patients. Three of these tumours were confirmed as neoplastic by biopsy, in another case radiological signs and clinical symptoms permitted definite assumption of malignancy (4/47 : 8.5 %). Histologically, only one of the latter four tumours could be identified as metastatic. In the remaining three cases we found second primary tumours. A follow up CT-scan of one of the remaining four cases showed normal results. In 3 cases the aetiology of the CT-findings remained unclear. CONCLUSION: Cervical lymph node metastases, tumour-size and recurrence of HNSCC are known risk factors for metastatic disease in HNSCC. Chest X-ray as staging procedure in patients with progressed or recurrent HNSCC may not be able to identify metastases or a second primary tumour of the lung. We therefore recommend a CT-scan of the chest as a routine procedure in such patients to optimise the pre-operative staging.

Sodium selenite is a potent radioprotector of the salivary glands of the rat: acute effects on the morphology and parenchymal function during fractioned irradiation.

In vitro studies show that sodium selenite is a potential radioprotector in normal cultural cells, but not in tumor cells. The aim of this study was to evaluate the cytoprotective potency of sodium selenite during a conventional fractioned irradiation of the salivary glands of rats. The head and neck area of male WAG/RijH rats was 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 resected at different stages and examined histopathologically. The evaluation of gland function was performed prior to and after radiotherapy by sialoscintigraphy. The 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; additionally, the number of necrotic acinar cells after the application of 60 Gy was reduced (control, 75% vs. sodium selenite, 30%). The sialoscintigaphical results confirmed these results: the loss in gland function in the control group was 74 vs. 44% (P < 0.05) in the sodium selenite group. Based on the morphological and sialoscintigraphical findings, a cytoprotective effect on the acute toxicity of the salivary glands of rats could be detected during irradiation with synchronous application of sodium selenite.

[Relapsing polychondritis -- a case report and review of the literature]. / Polychondritis recidivans et atrophicans - ein Fallbericht und Literaturübersicht.

PATIENT: A case of a 54-year-old woman with a three month history of recurrent bilateral chondritis of the auricles, cochlear and vestibular inner ear damage and conjunctivitis is described. The diagnosis was based only on clinical criteria (auricular chondritis, conjunctivitis, inner ear damage). Antinuclear antibodies, ANCA and HLA-DR 4 antigen were negative. The only laboratory abnormality was an elevated erythrocyte sedimentation rate. The patient has been treated successfully with Methotrexate 20 mg 1 x /week and Prednisone 15 mg/die for 4 month now. DISCUSSION: The relapsing polychondritis (RP) is a rare, multisystemic and potentially fatal disease. The pathogenesis and optimal therapeutic approach is poorly understood. The disease is characterized by episodic inflammation of cartilage such as auricular, nasal and laryngotracheal. Many other proteoglycan-rich structures like inner ear, eye, kidney and blood vessels, may be involved as well. RP has an equal sex prevalence. The majority of cases appear between 40 and 60 years. Auricular inflammation is the most common feature. Effectiveness of non-steroidal anti-inflammatory drugs, dapsone, immunosuppressive drugs and prednisone has been described. The overall survival rates were 74 % at 5 years and 55 % at 10 in one 1986 series. CONCLUSION: The most common clinical presentation of RP regularly involves ENT-structures. Therefore ENT-specialists should be familiar with this disease. A close interdisciplinary cooperation is essential for therapy and follow-up, because pulmonary and cardiac involvement are limiting prognostic factors.

[Salivary duct carcinoma of the submandibular gland]. / Speichelgangkarzinome der Glandula submandibularis.

BACKGROUND: Salivary duct carcinoma (SDC) is a rare adenocarcinoma of the salivary glands which usually occurs in the parotid gland (approx. 80%), but is also found in the submandibular gland (approx. 12%) and the minor salivary glands. Due to the low incidence of this tumour-particularly in terms of involvement of the submandibular and minor salivary glands-only limited clinical data is available. PATIENTS/METHOD: In a retrospective investigation, follow-ups of six patients with a SDC of the submandibular gland were analysed and the surgical measures evaluated for their efficiency. RESULTS: At the time of diagnosis, varying tumor stages were present (2xT1, 3xT2, 1xT1). Initial lymph node metastasis was observed in four (66.6%) of the six patients. In all patients, the submandibular gland was resected and neck dissection performed, in two cases (33,3%) this was followed by radiotherapy. Four patients developed a life-threatening local recurrence. Only one patient developed distant metastasis. Two thirds of the patients died due to tumor-related disease after an average of 35.5 months. CONCLUSION: The clinical course of patients with SDC of the submandibular gland exhibits a high (66.6%) rate of local recurrence, crucial for the following clinical course. The treatment of these patients, therefore, must include radical tumor resection as well as tissue resection with a wide margin.

[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.

The radioprotectors amifostine and sodium selenite do not modify the radiosensitivity of rat rhabdomyosarcomas.

BACKGROUND: Radiotherapy of head and neck tumors often leads to acute reactions of the adjacent normal tissues resulting e.g. in mucositis and xerostomia. Therefore, radioprotective drugs have been developed to reduce these effects. Studies on a tumor model using amifostine and sodium selenite adjuvant to fractionated irradiation should show whether the radioprotective effect on normal tissue leads to an increase of radioresistance in the tumor and its metastatic potential. METHODS: Rhabdomyosarcomas R1H of the rat growing subcutaneously in the right flank of male adult WAG/RijH rats were irradiated with 60Co-gamma rays (60 Gy/30 fractions/6 weeks). Amifostine (375 mg/m(2)), sodium selenite (15 microg/kg), and equivalent volumes of 0.9% saline were administered intraperitoneally 30 min before each irradiation. Tumor response was determined. Statistical analysis was performed using the post-hoc-test. RESULTS: Irradiation alone inhibited R1H tumor growth (AUC 86.8+/-18.3). The efficacy of irradiation during radiotherapy was significantly improved by amifostine (AUC 63.1+/-15.8) in comparison to the irradiated controls. The radiosensitizing effect of sodium selenite (AUC 73.6+/-21.3) as well as irradiation and amifostine plus sodium selenite (AUC 68.3+/-7.8) was less compared to the irradiated controls and not statistically significant. However, tumor growth delay and metastasis rate were not changed by the radioprotective drugs. Further, the administration of amifostine and amifostine plus sodium selenite induced an enhanced decrease of animal body weight except for sodium selenite in comparison to the controls. CONCLUSIONS: The application of amifostine and sodium selenite to conventionally fractionated irradiation have no influence on the radiosensitivity of the rhabdomyosarcoma R1H. The systemic toxicity of amifostine might be of importance for the radiation treatment of a patient.

[Lemierre syndrome: thrombosis of the internal jugular vein after tonsillectomy]. / Lemierre-Syndrom. Septische Jugularvenenthrombose nach Tonsillektomie.

BACKGROUND: Thrombosis of the internal jugular vein is a rare and critical disease which can also be a complication of a benign oropharyngeal infection (Lemierre syndrome). PATIENT: A 62 year old patient underwent septomplasty, endonasal turbinectomy, paranasal sinus surgery and tonsillectomy. The postoperative course was uneventful until the 11th post operative day when the patient reported a painful swelling on the right side of the neck. Color Doppler ultrasonography demonstrated thrombosis of the right internal jugular vein and a CT-scan showed a right sided cervical phlegmonous soft tissue inflammation originating from the right oropharynx. Despite immediate intravenous antibiotic treatment, the patient developed a septic infection and resection of the jugular vein was conducted. CONCLUSION: Lemierre syndrome is a rare condition which may also follow tonsillectomy. Under septic conditions, the resection of the internal jugular vein has to be performed to avoid serious complications.

[Histomorphologic and salivary gland scintigraphic findings in radiation-induced sialadenitis due to fractionated irradiation of the head and neck region of rats. A model for evaluating potentially radioprotective substances]. / Histomorphologische und sialoszintigraphische Befunde zur Radiosialadenitis unter fraktionierter Bestrahlung der Kopf-Hals-Region von Ratten. Ein Modell zur Evaluierung potenziell radioprotektiver Substanzen.

INTRODUCTION: The aim of this study was to correlate structural, histomorphological damage of the salivary gland with scintigraphic findings during fractioned radiotherapy. METHODS: The head and neck area of 27 WAG/RijH rats was irradiated with (60)Co-gamma-rays (60 Gy/30f/6 weeks). A port-system was implanted and (99m)Tc-pertechnetat applied at different stages of irradiation (0, 16, 30, 46, 60 Gy and 6 months post irradiation). RESULTS: After the application of 16 Gy an intra- and extra-cellular oedema developed in the salivary glands. The progressive vacuolisation (30 Gy) passed over into lipomatosis (46 Gy) and necrosis (60 Gy) in the parotid and mandibular glands. Six months after irradiation treatment, the chronic histomorphological damage corresponded to stage II according to Seifert. The corresponding loss in gland function was 13% (16 Gy); 26% (30 Gy); 57% (46 Gy); 75% (60 Gy) and 66.5% (6 months post irradiation). CONCLUSION: This animal model demonstrates the correlation between histomorphological and scintigraphic findings.

[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.

[Preliminary results for superficial parotidectomy using the ultrasonically activated scalpel (Ultracision Harmonic Scalpel)]. / Erste Ergebnisse zur Technik der laterofazialen Parotidektomie mit dem ultraschallaktivierten Skalpell (Ultracision Harmonic Scalpel(R)).

BACKGROUND: The high density of blood vessels in the parotid gland, the direct vicinity to the facial nerve and the narrow surgical situs require efficient intra- and postoperative hemostasis. The ultrasonic scalpel (US) accomplishes both tissue dissection and vessel coagulation simultaneously by an ultrasonically activated shear movement of 55 500 Hz. The combination of hemostasis and tissue dissection particularly qualifies US for use in surgery of the parotid gland. Until now, there have been no published studies about application of US in surgery of the parotid gland. METHOD: 20 patients with benign parotid tumors treated with a conventional technique of superficial parotidectomy and 20 patients with a superficial parotidectomy using the ultrasonically activated scalpel were examined in regard to intra- and postoperative hemostasis, wound healing and postoperative pain. Also, the quality of the histopathological specimen obtained by US was evaluated. RESULTS: In 85 % (17/20) of superficial parotidectomy efficient intraoperative hemostasis did not require electrocoagulation. In 15 % (3/20) of parotid tumors additional bipolar electrocoagulation were required because of venous bleeding from vessels exceeding 2.0 mm in diameter. Postoperative bleeding did not occur at all. Wound healing was uneventful in all cases. Surgery-related postoperative pain was not intensified. Time of operation was shortened. Histopathological evaluation, especially in the margin area, was not impaired. CONCLUSION: The US offers tissue dissection with effective intra- and postoperative hemostasis. The combination of simultaneous tissue dissection and hemostasis enables a good overall view and control of the surgical site. In addition, based on the mechanical function the US has only a minimal thermal effect on neighboring tissues and enables controlled tumor resection without damaging the facial nerve.

Investigation of radiosialadenitis during fractioned irradiation: sialoscintigraphical and histomorphological findings in rats.

Xerostomia is the most debilitating side effect induced by irradiation of head and neck tumours and is caused by irradiation damage to the salivary glands. The aim of this study was to correlate structural histomorphological damages and sialoscintigraphical findings during fractioned radiotherapy. The head and neck area of 27 WAG/RijH rats was irradiated with 60Co-gamma rays (60 Gy/30f 6 weeks). To evaluate salivary gland function, a port system was implanted, and 99mTc-pertechnetate was applied at different stages of irradiation (0, 16, 30, 46, 60 and 6 months post-irradiation). In the course of treatment the parotid glands were examined histopathologically. Rat salivary glands developed a dose-dependent radiosialadenitis. After a dose of 16 Gy an intra- and extra-cellular oedema developed in the salivary glands. Progressive vacuolisation (30 Gy) developed into lipomatosis (46 Gy) and necrotic changes (60 Gy) in the parotid glands. Six months after irradiation treatment, the chronic histomorphological damages corresponded to stage II according to Seifert. The corresponding loss in gland function investigated by measurement of the 99mTc-pertechnetate uptake of the salivary glands was 13% (16 Gy), 26% (30 Gy), 57% (46 Gy), 75% (60 Gy) and 66.5% (6 months post-irradiation). The presented animal model is suitable to demonstrate the correlation of histomorphological and sialoscintigraphical findings.

[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.

[Surgical treatment of rhinophyma with the ultrasonic scalpel (Ultracision Harmonic Scalpel)]. / Die operative Therapie des Rhinophyms mit dem ultraschallaktivierten Skalpell (Ultracision Harmonic Scalpel).

BACKGROUND: There are multiple surgical approaches to the treatment of rhinophyma. Because of the exceptional vascularity of the nose, traditional surgical approaches to the management of rhinophyma are fraught with persistent intraoperative hemorrhage. Hemorrhage that is controlled with electrocautery or laser by a combination of excision of rhinophymatous tissue and simultaneous hemostasis invariably damages cartilage by thermal injury. The UltraCision Harmonic Scalpel achieved a tissue dissection with a simultaneous hemostasis and only minimal thermal tissue injury. To this date, in Europe no studies have been published on the use of the Ultracision Harmonic Scalpel in the surgical treatment of rhinophyma. PATIENTS AND TREATMENT: 6 patients had surgical treatment of rhinophyma with the UltraCision Harmonic Scalpel. The objective of the study was therefore to analyse the handling indication, the efficiency of intra- and postoperative hemostasis, the wound healing, the postoperative pain and the histologic results of tissue resections. RESULTS: Because of the effective intraoperative hemostasis supplementary hemostasis was not required in any examined patient. The efficient hemostasis and the tactile experience of the UltraCision Harmonic Scalpel enabled an accurate sculpting of the nose. Postoperative pain sensation was minimal. Wound healing was uneventful in all cases. Postoperative reepithelialization occurred within 28 days. Delayed complications like scarring did not occur within a median follow - up of 13 month. Histopathological evaluation was possible in all cases. CONCLUSION: The UltraCision Harmonic Scalpel offers a surgical treatment of rhinophyma with efficacious intra- and postoperative hemostasis. The combination of simultaneous tissue dissection and hemostasis enables a good overall view and control of the surgical site. Based on its mechanical function, the UltraCision Harmonic Scalpel has only a little thermal effect on neighbouring tissues and a good tactile experience that enables a controlled tissue resection. The UltraCision Harmonic Scalpel combines the advantages of tissue dissection and simultaneous hemostasis with the controlled handling of the traditional scalpel in rhinophyma surgery.

[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.