[Physical Properties of Squamous Cell Carcinoma Cells using Atomic Force Microscopy]. / Bestimmung elastischer Eigenschaften von Plattenepithelkarzinomzellen mittels Rasterkraftmikroskopie.

INTRODUCTION: Malignant and benign cells differ according to their elasticity. An atomic force microscope is a useful tool for measuring these mechanical cell properties. If cells of different dignity show different resonance behavior, due to their different elasticity, a selective ablation of specific tissue types by ultrasound would be possible. The goal is a highly selective ablation of tumor tissue without damaging healthy tissue. MATERIALS AND METHODS: We performed elasticity measurements of tumor cells (UD-01 cell line) with an atomic force microscope. In a further step, an ultrasound applicator has been positioned and the morphological changes of the cells during the treatment were documented. RESULTS: Different elasticities on the squamous cells were measured, depending on the location. Below a defined maximum amplitude the morphological cell changes were caused solely by ultrasonic excitation. SUMMARY: The atomic force microscope is suitable for the determination of the individual cell elasticity. The data collected could be the basis for treatment modalities that lead to a very selective damage for malignant cells.

Primary tumors and tumor-like lesions of the eustachian tube: a systematic review of an emerging entity.

Eustachian tube (ET) primary tumors and tumor-like lesions are rare diseases presenting with common ear, nose and throat symptoms. Pathology can range from developmental anomalies to high malignant neoplasms. Hence this review aimed at suggesting a classification and outline relevant aspects of ET primary tumors and tumor-like lesions, describing clinical findings, diagnostic management and therapeutic approaches. MEDLINE, CINAHL, OVIDSP, HIGHWIRE, and GOOGLE databases were searched from inception to July 2011 for relevant studies. Further papers were identified by examining the reference lists of all included. Sixty-five papers met the inclusion criteria, enclosing 78 cases. Case reports are increasing in the past few years. Benign lesions and tumor-like lesions of ET have been reported. Moreover, melanomas, carcinomas, and sarcomas can affect the ET as a primary site.

[Biology and relevance of stem cells in squamous head and neck cancer: latest insights and review of literature]. / Biologie und Bedeutung von Tumorstammzellen in der HNO: Neueste Erkenntnisse und Zusammenfassung der aktuellen Literatur.

The initiation, growth, recurrence and metastasis of head and neck squamous cell carcinomas (HNSCC) and other cancers have recently been related to the presence of cancer stem cells (CSC). Cancer stem cells have some characteristics in common with tissue stem cells like unlimited self renewal and the expression of stem cell factors. CSC express specific markers that vary considerably depending on tumor type or tissue of origin--the discovery of an universal marker has not yet been made. Compared to the bulk tumor mass, CSC are less sensitive to chemo- and radiotherapy and also have a lower immunogenicity. Another concept that explains the seeding of metastases is the epithelial-mesenchymal transition of CSC. CSC-targeted therapies may change the prognosis of patients with HNSCC in the future. Recent knowledge on the role of CSC in HNSCC is reviewed, and known CSC markers as well as possible therapeutic targets are described.

Cystatin C - a fast and reliable biomarker for glomerular filtration rate in head and neck cancer patients.

PURPOSE: Determination of renal function is a prerequisite for planning therapy in cancer patients. Limitations of creatinine as marker for the glomerular filtration rate (GFR) led to the proposal of cystatin C as a more accurate biomarker especially in mild renal insufficiency or in patients with low muscle mass. We compared the accuracy of cystatin C- and creatinine-based equations to estimate GFR in head and neck cancer (HNC) patients receiving platinum-based radiochemotherapy. PATIENTS AND METHODS: The study population consisted of 52 HNC patients (GFR range, 37-105 mL/min/1.73 m(2) complemented by 17 patients with known renal insufficiency (GFR range, 10-60 mL/min/1.73 m(2)). Intraclass correlation coefficients were calculated between the reference method (51)Cr-EDTA clearance and estimated GFR by creatinine clearance and equations based on creatinine (Cockroft-Gault, modification of diet in renal disease (MDRD), Wright) or cystatin C (Larsson, Dade-Behring, Hoek). In addition, sensitivity and specificity to discriminate GFR > 60 mL/min/1.73 m(2) were evaluated by receiver operating characteristic curve (ROC). RESULTS: The highest correlation coefficients were found for the cystatin C-based estimates in comparison with creatinine-based estimates or creatinine clearance, even though Bland-Altman plots revealed GFR overestimation for all equations tested. The cystatin C-based Hoek formula exhibited the highest overall precision and accuracy. GFR of < 60 mL/min/1.73 m(2) was assumed as a cut-off for chemotherapy. ROC analyses revealed the highest AUC to predict a GFR > 60 mL/min/1.73 m(2) for the creatinine-based Wright formula, closely followed by the MDRD formula and cystatin C-based equations of Larsson, Dade-Behring, and Hoek. CONCLUSION: Cystatin C-based GFR estimates showed the overall strongest correlation to the reference method. Thus, we recommend cystatin C for GFR estimation in HNC patients as an alternative method to the estimated creatinine clearance in clinical practice.

Life after cancer in India: coping with side effects and cancer pain.

The article aims to understand the coping strategies of postsurgery head and neck cancer patients in Mumbai, India. A descriptive research design with a sample of 80 patients suffering from head and neck cancer was selected to analyze their coping strategies in relation to sociodemographic profile and illness characteristics. The findings of the study highlighted that the spiritual methods of coping (such as prayer and meditation, adopting a positive attitude) were the most frequently used mainstream coping strategy, apart from other traditional methods (such as taking medications, indulging in exercise and activities to divert one's attention, etc.) of coping. The findings of the study help to broaden the understanding of various psychosocial aspects faced by the patient in India and provide progressive recommendations to improve the quality of life of the patient suffering from cancer.

Reproducibility of technetium-99m-MAG3 clearance using the Bubeck method.

UNLABELLED: The objective of this study was to estimate the reproducibility of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) clearance calculated using a single-sample method. METHODS: One hundred forty-seven patients with urological or ear, nose and throat cancer were analyzed in a retrospective study. Each patient had at least two clearance studies with 99mTc-MAG3 before chemotherapy treatments to monitor renal function. Up to five clearance studies per patient were considered. The reproducibility was estimated by comparing two consecutive investigations. Pairs of investigations with a change in split renal function of more than 5% or an interval of more than 50 days were excluded. Clearance was determined using the Bubeck method. For each pair of consecutive clearance data, the difference between the first and the second measurements was expressed as a percentage of the mean value of the two measurements. The mean of these normalized differences represents the systematic deviation, and the s.d. represents the reproducibility of the compared clearances. RESULTS: After the selection, 242 pairs of consecutive clearance data remained for comparison. Significantly different clearances were observed only between investigations 0 and 1 and between 4 and 5. The systematic deviation of these comparisons totaled -3.8% and -5.7%, respectively. In the other comparisons, no significant deviation induced by the chemotherapy was found. The reproducibility calculated for all comparisons totaled 11.7%. CONCLUSION: The error of reproducibility of 99mTc-MAG3 clearance using the Bubeck method was < or =11.7%. This was an acceptable value, taking into account the greater fluctuation of tubular function compared with the glomerular filtration rate.

Pediatric head and neck lesions: assessment of vascularity by MR digital subtraction angiography.

BACKGROUND AND PURPOSE: Pediatric head and neck lesions can be difficult to characterize on clinical grounds alone. We investigated the use of dynamic MR digital subtraction angiography as a noninvasive adjunct for the assessment of the vascularity of these abnormalities. METHODS: Twelve patients (age range, 2 days to 16 years) with known or suspected vascular abnormalities were studied. Routine MR imaging, time-of-flight MR angiography, and MR digital subtraction angiography were performed in all patients. The dynamic sequence was acquired in two planes at one frame per second by using a thick section (6-10 cm) selective radio-frequency spoiled fast gradient-echo sequence and an IV administered bolus of contrast material. The images were subtracted from a preliminary mask sequence and viewed as a video-inverted cine loop. RESULTS: In all cases, MR digital subtraction angiography was successfully performed. The technique showed the following: 1) slow flow lesions (two choroidal angiomas, eyelid hemangioma, and scalp venous malformation); 2) high flow lesions that were not always suspected by clinical examination alone (parotid hemangioma, scalp, occipital, and eyelid arteriovenous malformations plus a palatal teratoma); 3) a hypovascular tumor for which a biopsy could be safely performed (Burkitt lymphoma); and 4) a hypervascular tumor of the palate (cystic teratoma). CONCLUSION: Our early experience suggests that MR digital subtraction angiography can be reliably performed in children of all ages without complication. The technique provided a noninvasive assessment of the vascularity of each lesion that could not always have been predicted on the basis of clinical examination or routine MR imaging alone.

Quantitative analysis of the drainage after neck dissection.

The goals of this study are to determine the normal volume and lipid values of the drainage after neck dissection (ND) and to evaluate the changes of these values according to the type and side of the ND. Ninety-seven uncomplicated NDs involving zones I through IV were evaluated prospectively in this study. The most important result of the analysis of the drainage is that levels of triglyceride and cholesterol in the drainage were lower than serum levels in all but 1 case (P< 0.001). When matched for the type and side of the dissection, only mean total drainage volume was significantly higher in radical NDs than in selective NDs (P = 0.001). The normal volume and lipid values of neck drainage are reported in this study. Being aware of the changes in these values may help early diagnosis of some pathologic conditions.

Dedifferentiated liposarcoma of the pyriform sinus: report of a case and review of the literature.

Laryngeal and hypopharyngeal liposarcomas are extraordinarily infrequent tumors. To the best of our knowledge there are fewer than 40 well-documented cases reported to date. Almost all of them are well-differentiated liposarcomas, with only 2 laryngeal-hypopharyngeal dedifferentiated liposarcomas. Dedifferentiated liposarcoma is defined as a well-differentiated liposarcoma with areas of high-grade spindle cell nonlipogenic sarcoma. The well-differentiated areas may be of a lipoma-like, sclerosing, or mixed type, and the dedifferentiated areas most frequently are of malignant fibrous hystiocytoma-like type. Despite its commonly pleomorphic histology, dedifferentiated liposarcoma does not behave as aggressively as most pleomorphic sarcomas of adulthood; however, it has the capacity to metastasize, in contrast to its well-differentiated counterpart. We present a case of dedifferentiated liposarcoma arising in the pyriform sinus, an event only twice reported previously in the literature.

The infected wound and its management.

The infected wound is one of the most frequent causes of delayed wound healing. Even in the face of appropriate antibiotic prophylaxis, infections can occur in 10% to 20% of clean-contaminated procedures in the head and neck. The authors describe their comprehensive approach to prevent and manage the infected wound at the head and neck area.

Sensitization of head and neck squamous cell carcinoma cells to Fas-mediated apoptosis by the inhibition of Bcl-X(L) expression.

BACKGROUND: Various types of malignant tumor cells are known to acquire resistance to Fas receptor (Fas)-mediated apoptosis. In Fas-sensitive cells, Fas-mediated apoptosis is observed when anti-Fas antibody is bound to Fas. Bcl-2 and Bcl-X(L) are representative anti-apoptosis proteins reported to be capable of suppressing Fas-mediated apoptosis. OBJECTIVE: To investigate the mechanism of resistance acquisition to Fas-mediated apoptosis in cultured human head and neck squamous cell carcinoma cells (HNSCCs). METHODS AND RESULTS: We applied an anti-Fas antibody (CH11) to Fas-expressing HNSCCs (HSC-2) and the CH11 did not induce cell death in HSC-2. Treatment with actinomycin D (ActD) converted the phenotypes of HSC-2 from CH11-resistant to CH11-sensitive. Western blot analysis showed no differences between ActD-treated and ActD-untreated HSC-2 in the expression of Bcl-2. On the other hand, the expression of Bcl-X(L) was greatly reduced in ActD-treated HSC-2. Moreover, the reduction of Bcl-X(L) by specific antisense oligonucleotide treatment enhanced the CH11-induced cell death of HSC-2. CONCLUSION: Our data suggest that Fas-signaling might be regulated by a Bcl-X(L)-inhibitable step in CH11-resistant HSC-2.

[Oropharyngeal aerobic flora in patients hospitalized in an ORL department]. / Etude de la flore aérobie oropharyngée chez les patients hospitalisés dans un service d'O.R.L.

As patients with E.N.T. carcinoma have relative frequent infectious complications of E.N.T. area, we have carried out a study or oropharyngeal colonization by aerobic bacteria and fungi in 84 hospitalized patients. The results of the tests are analysed according to different parameters, essentially the presence or the absence of neoplasia and antibiotherapy. The presence of one of these two factors does not substantially modify oropharyngeal flora of patients. However their association coincides with a height percentage of colonies of enterobacteriaceae, of pseudomonas and of fungi.

[Treatment of intractable pain in ORL cancer]. / Traitement des douleurs irréductibles des cancers de la sphère ORL.

Numerous effective treatments are available to relieve the intractable pain of terminal E.N.T. cancers when aetiological therapies are no longer of any use. These treatments must be prescribed as a progressive therapeutic scale ranging from analgesics, and notably morphine which remains the basic drug, to the classical or stereotactic surgical operations. To these must now be added other routes of administration of morphine (e.g. intraventricularly) which in some cases give unexpected results.

[Prognosis of epidermoid carcinoma of oropharyngeolaryngeal region]. / Pronostic des carcinomes épidermoïdes oro-pharyngo-laryngés.

Knowledge of pronostic factors is essential for assessment of therapeutic procedures and for individual treatment selection and adjustment for patient with squamous cell carcinomas of the head and neck. This paper reviews known clinical, histological and biological prognostic factors and their prognostic significance in predicting survival, response to treatment and locoregional and distant recurrences. Most significant criteria include tumor site and extension, absence or presence of cervical lymph nodes and their location, size and mobility. Histological, disease-related factors include number and location of involved nodes, and extra-capsular spread, which is the most significant independent factor. Response to treatment is an essential factor which should be used to alter or complement the treatment plan. Other treatment-related factors include technical parameters that can impact the outcomes and should be taken into account when assessing treatment procedures. Preliminary studies suggest that biological factors may be used as efficient predictors within the next few years but they are still under evaluation and therefore are not to be used in routine practice. They are expected to improve prediction of response to radiotherapy and chemotherapy as well as prediction of the risk of distant metastases and of metachronous head and neck cancers.

First bite syndrome.

Based on a review of the indexed medical literature (PubMed database), the authors describe the clinical features leading to the diagnosis of first bite syndrome, the pathophysiology of this syndrome and analyse the various treatment options available to otorhinolaryngologists to manage this syndrome.

Severe progressive sensorineural hearing loss improved after removal of large jugular foramen schwannoma.

We report a very rare case of hearing improvement after removal of the intracranial part of a jugular foramen schwannoma (JFS) presenting with chronic and severe progressive sensorineural hearing loss (SNHL). The patient presented with progressive hearing impairment in his right ear, lasting 2 years. The patient's pure tone audiogram revealed severe SNHL. His speech discrimination score (SDS) was 0%. Auditory-evoked brain responses (ABRs) comprised only I waves following 30-100dB stimulation, although distortion-product otoacoustic emissions (DPOAEs) had good responses. These test results indicated that his hearing impairment was retrocochlear SNHL. Magnetic resonance imaging revealed within the right jugular foramen a large intracranial-extracranial tumor that compressed the brainstem. The intracranial part of the tumor was resected through retrosigmoidal craniotomy, and the tumor was pathologically diagnosed as a schwannoma. Several months after the operation, the patient's auditory thresholds improved to a level consistent with mild SNHL, ABR V waves emerged following 60-90dB stimulation, and SDS improved significantly to 95%. This case demonstrates that hearing improvement can be achieved after surgery for JFS presenting with severe and chronic progressive SNHL, and that good DPOAE responses and the presence of ABR I waves may be predictors of postoperative hearing recovery in JFS.

Cortical representation sites of mimic movements after facial nerve reconstruction: a functional magnetic resonance imaging study.

OBJECTIVES/HYPOTHESIS: To describe cortical reorganization after classic hypoglossal-facial nerve anastomosis (HFA) (four patients), hypoglossal-facial nerve jump anastomosis (HFJA) (three patients), and facial nerve interpositional graft (FNIG) (three patients). STUDY DESIGN: Prospective case series. METHODS: Functional magnetic resonance imaging (fMRI) was performed during lip and tongue movement using a block or an event-related design. RESULTS: Despite the presence of some intersubject variability, the following general brain activation patterns were revealed: As expected, lip movements after FNIG led to selective brain activation in the original facial motor cortex, and lip movements after HFA were associated with activation in the hypoglossal motor cortex. Following HFJA, lip movements resulted in overlapping activation encompassing both the original facial and the hypoglossal motor cortex, but tongue movements led solely to strong activation within the original hypoglossal motor cortex. In contrast, tongue movements after HFA were associated with strong activation in the original hypoglossal motor cortex and weaker activation in the facial motor cortex. CONCLUSIONS: Direct facial nerve repair (FNIG) leads to restoration of the original cortical activation. A cross nerve suture (HFA or HFJA) changes cortical activation and leads to different patterns of cortical activation during lip and tongue movements.

[Chronic pain therapy for patients with head and neck tumors]. / Therapie chronischer Schmerzen bei Patienten mit Kopf-Hals-Tumoren.

Patients with tumors of the head and neck region commonly suffer from chronic pain, which is often treated insufficiently. Pain management according to the WHO analgesic ladder can effectively reduce pain in most patients. For head and neck cancer, specific aspects of tumor localization and psychosocial factors must be taken into consideration.

[Mucins in otorhinolaryngology]. / Muzine auf dem Gebiet der HNO-Heilkunde.

BACKGROUND: Mucins are glycoproteins of high-polymer structure. They are an important component of the mucous layer covering the epithelia of the upper aerodigestive tract. Until now there has been little interest with regard to mucins in otorhinolaryngology. METHODS: The present knowledge about mucins of the upper aerodigestive tract is presented. A MEDLINE search was conducted for English- and German-language articles published from 1966 to the present. RESULTS: Thirteen different mucins named MUC 1-13 have been subdivided based on the classification system used by the Human Gene Mapping Committee. Besides mucins, small mucin-associated peptides, called trefoil factor peptides, have attracted much interest. CONCLUSIONS: Classification and attribution of the mucins found in the middle ear, larynx, oropharynx, esophagus, and nasolacrimal ducts has yet to be done. Also, little is known about the distribution of trefoil factor peptides in the upper aerodigestive tract.