[The role of radiotherapy in the treatment of granuloma gangraenescens (lethal midline granuloma]. / Die Rolle der Strahlentherapie in der Behandlung des Granuloma gangraenescens (letales Mittellinien-Granulom).

The granuloma gangraenescens in the oral, maxillary and facial region is a rare disease. It is a destroying process in the region of palate, nose, paranasal sinuses, cheeks and orbit with characteristic signs of granulomatosis, infection and malignancy. The disease shows often a lethal development with cachexia or sepsis. Besides local inflammations and tumors, the granulomatosis of Wegener, and the so-called necrotizing sialometaplasia are above all to be excluded by differential diagnosis. Five cases are presented in order to describe the diagnostic and therapeutic problems. In literature, the greatest efficacy is attributed to radiotherapy, however, a detailed definition of the most efficient irradiation conditions cannot be given yet because of the small number of cases. Good long-term results or recoveries can be achieved in 75 to 80% of cases by a relatively high radiation dose of 40 to 50 Gy administered within four to five weeks. During the observation time of two to six years, no one of the five patients treated here only by megavoltage therapy showed a recurrence.

[Mass data and psychoacoustic interpretations of patients with 8-channel cochlear implants (author's transl)]. / Messdaten und psycho-akustische Auswertung mit 8-kanal-Hörprothese.

Six patients are described following insertion of an 8-channel cochlear implant. The prosthesis was modified from the Vocoder technique, and was implanted by a simplified method of the procedure previously reported by us. In addition to the perception of background noise as well as the differentiation of periodicity and frequencies, a distinct improvement of the patients' speech discriminations could be observed with this technique.

Vidian neurectomy: neuroanatomical considerations and a report on a new surgical approach.

If conventional treatment fails, vidian neurectomy is a viable alternative for therapy of chronic rhinitis with recurrent polyposis of the nose and sinuses. From a neuroanatomical point of view beneficial and adverse effects of this surgical procedure are discussed. According to our own investigations and experiences, vidian neurectomy should be performed together with clearing out of the sinuses in every case. Beginning with this precondition a new surgical approach was developed: the vidian nerve is detected through a transethmoidal route in the pterygoid canal at the bottom of the sphenoid sinus and dissected using the operation microscope.

[First observations of a cochlear-implant operation (author's transl)]. / Erste Beobachtung nach einer Cochlear-Implant-Operation.

We report on our observations following our first cochlear-implant operation in a patient, and have found that the implantation of a single electrode can allow the patient to realize background noise.

Nasopharyngeal and adjacent neoplasms: a clinico-pathologic and immunologic study.

Thirteen cases of nasopharyngeal carcinoma (NPC) and 16 cases of non-NPC tumors in the nasopharynx or in adjacent locations were investigated clinically, immunologically, and pathologically. All tumors were classified according to the TNM classification, and the stage and course of the disease was correlated with the histological tumor type, the T- and B-cell distribution in tumor tissue and in the peripheral blood, as well as with antibody titers against Epstein-Barr virus (EBV). The results showed a positive correlation of decreased T- and B-cells in tumor tissue and of decreased T-cells in the peripheral blood with the extend of the tumor in both NPC and non-NPC cases, with some exceptions of lymphocyte rich neoplasms (lymphoepithelial carcinoma and malignant lymphoma). Antibodies against EBV (early antigen and capsid antigen) became progressively elevated with increasing tumor stage in NPC-cases but not in non-NPC cases. The latter, however, was observed only in two histological types of NPC's: anaplastic carcinoma and lymphoepithelial carcinoma; titers in the remaining tumor types stayed insignificant.

[Classification of malignant lymphomas of the neck: combined morphological, immunocytological, serological and tissues culture studies (author's transl)]. / Klassifikation maligner Lymphome des Halsbereiches: Kombinierte morphologische, immunzytologische, serologische und Zellkulturuntersuchungen

81 untreated malignant lymphomas of the neck were classified morphologically according to the German Kiel classification and to the American classification of Rappaport and Berard and these tumors were typed immunologically as to their T- or B-cell nature. Cells from 16 of these patients were subsequently grown in tissue culture for periods up to seven months. Tissue culture cells were monitored as to spontaneous variations in the morphologic cell type and to the expression of T- or B-cell surface determinants. In addition in 10 patients sera were tested for anti-Epstein-Barr virus (EBV) antibodies. The results of these investigations were correlated with the course of the individual neoplastic disease. Significantly elevated titers against EBV antigens were detected primarily in 8 of 10 patients, mainly in lymphocytic lymphomas respective lymphoplasmacytoid immunocytomas. All such neoplasms belonged immunologically to B-cell lymphomas and were readily grown in tissue culture. The morphological cell type and the expression of B-cell determinants showed some variation during the culture period. In contrast,lymphomas of EBV-negative patients or patients with low EBV-titers grew poorly in tissue culture and remained morphologically more stabile. Immunocytologically they belonged to tumors with B- and T-cell deficiency and were classified primarily as histiocytic lymphomas and as Hodgkin's lymphomas. The clinical course in slow proliferating tumors seemed to be rather disadvantageous.

[Percent distribution of B-Lymphocytes in human tonsils at various ages]. / Untersuchungen über das Verteilungsmuster immunkompetenter Zellen mit Antiköperrezoptoren (B-Zellen) in Tonsillen von Patienten verschiedener Altersgruppen

B-Lymphocytes of the classes G, M and A were determined by use of heavy-chain-specific fluorescent antisera from 67 children between 2 and 14 years of age and from 15 adults up to 60 years of age. Tonsils from which viable cell suspensions were investigated for B-Cells were classified histologically, according to their degree of lymphatic hyperplasia and inflammation. With increasing age, a statiscally significant decrease in percent G- and M-cells was observed while A-cells remained unchanged. With increasing severity and extent of inflammation and lymphatic hyperplasia, there occured a mild increase in percent M-cells. G-cells did not exhibit major changes under such conditions. It is suggested, that the tonsil may represent an early and fast reaching immunocompetent organ primarily determined for the production of large molecular IgM and IgA of less specificity.

[Membrane receptors of lymphoreticular cells in hyperplastic and neoplastic diseases of the lymphatic system]. / Membranrezeptoren lymphoreticulärer Zellen bei hyperplastischen und neoplastischen Erkrankungen des lymphatischen Systems

The results of T- and B-cell determinations are described in 105 cases of lymphoreticular and lymphoepithelial neoplasia, and are compared to similar investigations of 582 cases as published in the literature. In addition, T- and B-cell values are determined in blood of 35 healthy individuals, in 12 normal lymph nodes, as well as in hyperplastic conditions of lymph nodes from 30 patients and of tonsils from 85 patients. Cell characterizations are done by immunofluorescence and use of monospecific anti-immunoglobulin antisera (H chain specific), anti-thymus antiserum, as well as by the E-rosette test. While normal blood and normal and hyperplastic tissues show a polyclonal distribution or proliferation of lymphoreticular cells, neoplastic conditions are often characterized by an exuberant, possibly monoclonal proliferation of one cell type. According to this, lymphoreticular neoplasias are immunologically grouped into four main classes: B-cell neoplasias comprising most of the chronic lymphocytic leukemias, well differentiated lymphocytic lymphomas, BURKITT's tumor, follicular lymphoma BRILL-SYMMERS, and hairy cell leukemia. T-cell lymphomas represent a large part of poorly or undifferentiated leukemias of children, poorly differentiated lymphocytic lymphomas, prolymphocytic leukemia, and Sézary's syndrome. Monocytic neoplasias are malignant histiocytoses and leukemic reticuloendothelioses. A fourth group, which probably is not homogeneous and might be further classified in the future by use of more sophisticated methods, consists of tumors with T- and B-cell lack. Such tumors are histologically classified as Hodgkin's lymphomas, a certain number of histiocytic lymphomas, and mycosis fungoides. The prognostic and pathogenetic implications of a combined morphological and immunological classification of lymphoreticular neoplasias are briefly outlined.

[The distribution of B-lymphocytes in lymphoepithelial tissues as well as in tumors of the neck-, nose-, and throat region derived from lymphoreticular and lymphoepithelial tissues (author's transl)]. / Die Verteilung von B-lymphoiden Zellen im lymphoepithelialen Gewebe und in lymphoretikulären sowie lymphoepithelialen Tumoren des Hals-Nasen-Rachenbereiches

B-Lymphocytes carrying IgG-, IgM,- and IgA-surface receptors were estimated by fluorescence microscopy in the palatine tonsil of 50 patients aged 3 to 18 years as well as in 44 patients with various types of malignant lymphoms and lymphoepithelial carcinomas. Hyperplastic tonsillartissue contains large numbers of B-cells with a marked variability in concentration (4-30% IgG-cells, medium 12,9%;6-36 IgM-cells, medium 23.4%;3-38% IgA cells, medium 20.8%). There appears to exist an age-dependent increase in IgM-cells and an increase in IgG-and IgA-cells in patients with numerous recurrent infections of the upper respiratory tract. Malignant lymphomas can be grouped into three main categories: Such with a predominance of one B-cell line (above 75-80% of one immunological cell type); these include primarily malignant lymphomas of the well differentiated lymphocytic type (IgM and IgA receptors). Secondly, such with a significant decrease in B-cells (below 10%) which include primarily malignant lymphomas of the poorly differentiated lymphocytic type. Thirdly, such with an increased B-cell content but with more than one cell line participating in cell proliferation. The latter ones comprise certain cases of Hodkin's lymphomas. Lymphoepithial carcinomas are charactersized by a significant decrease in total B-cell content, except for IgE- and IgD-cells which were not investigated. The results show that the immunologic classification of malignant lymphomas correlates only to a certain degree with the morphologic classification; i.e. the same morphologic type of tumor may possess different immunologic characteristics. Since the immunologic characteristics may reflect a certain functional potential of these tumors as well as probably a certain kind of immunologic incompetence prior to tumor development, it is suggested, that future morphologic investigations of malignant lymphomas and lymphoepithelial carcinomas are combined with immunologic classifications.