Evaluation of a nasopharyngeal stent in patients with obstructive sleep-related breathing disorders.

OBJECTIVE: This study was performed to evaluate the therapeutic effect and diagnostic value of a novel nasopharyngeal stent (Nastent; Corinium Medical Equipment Ltd., Cirencester, UK). The Nastent is designed to stent palatal collapse in patients with sleep-related breathing disorders. METHODS: The study was conducted from 2018 to 2019. Patients who did not qualify for continuous positive airway pressure therapy underwent split-night examination with an inserted Nastent for the first half of the night. The next morning, drug-induced sleep endoscopy (DISE) was performed. RESULTS: Of the 122 enrolled patients, 21 were excluded because of Nastent intolerance (n = 14) or technically invalid examinations (n = 7). Among the remaining 101 patients, in correlation with DISE, the apnea-hypopnea index was significantly reduced in patients with palatal obstructions, mainly in those with anteroposterior collapse patterns. The Nastent did not influence retrolingual or multilevel obstructions. Using a 40% reduction of the apnea-hypopnea index by the Nastent as a cut-off value, 85.7% of soft palate obstructions were detected compared with DISE. CONCLUSIONS: The Nastent is a viable tool to reduce palatal obstructions, although it is not readily tolerated. It may also be helpful for diagnosis of sleep-related breathing disorders when DISE is unavailable.

[Metastasation of cutaneous squamous cell carcinoma in the ENT-Area]. / Metastasierung kutaner Plattenepithelkarzinome im HNO-Bereich.

OBJECTIVES: Our aim was to investigate the metastasis behavior and its prognostic Factor for Survival, with our clinical data. MATERIALS AND METHODS: This retrospective study included 29 Caucasians, with a squamous cell carcinoma of the skin in the head and neck region, at our tertiary clinic between 2004 and 2016. All Patients received a Tumorresection and Neckdissection. We used either Ultrasound or Computer-Tomography (conventional or PET-CT) for our preoperative Staging and the Follow-up. The Patients were classified according to metastatic behavior and the corresponding survival rates were determined. RESULTS: We found 11 patients with cervical metastases, 4 patients with parotideal metastases, 5 patients had Metastasis in both locations. In 9 patients a prophylactic neck dissection was performed. A loco regional tumor recurrence occurred in a total of 24 % of the cases, these cases were all associated with cervical metastasis. The 5-year survival rate in these cases was 71 %; in contrast, it was 100 % when parotideal metastasis alone occurred. In the group with prophylactic neck dissection, one case was diagnosed with occult metastases. CONCLUSIONS: Cervical metastasis is associated with a poorer prognosis compared to parotideal metastasis. The survival rate after surgical therapy and, if necessary, additional adjuvant radiotherapy is generally good (79 %). The role of prophylactic neck dissection in cN0 with corresponding risk factors, has not been conclusively clarified.

Retrospective validation of a ß-trace protein interpretation algorithm for the diagnosis of cerebrospinal fluid leakage.

BACKGROUND: Cerebrospinal fluid (CSF) leakage is a rare condition that can potentially lead to the development of serious complications. In the last decade, ß-trace protein (ß-TP) has been shown to be a valuable immunological biomarker that allows prompt and non-invasive identification of CSF leakage. At our institution, the measurement of ß-TP has been included in the diagnostic work-up of CSF leakage for more than 10 years. According to our diagnostic algorithm, the presence of CSF in secretion is excluded when ß-TP values are <0.7 mg/L, whereas ß-TP values ≥1.3 mg/L indicate the presence of CSF in secretion. ß-TP values between 0.7 and 1.29 mg/L indicate the presence of CSF if the ß-TP ratio (ß-TP secretion/ß-TP serum) is ≥2. This study aimed to validate this diagnostic algorithm using clinically defined nasal/ear secretions. METHODS: We performed a retrospective statistical analysis of three ß-TP interpretation strategies using data of 236 samples originating from 121 patients with suspect CSF leakage received at our laboratory between 2004 and 2012. RESULTS: The highest odds ratio was obtained when the proposed algorithm has been used for the interpretation of ß-TP results, showing a sensitivity of 98.3% and a specificity of 96%. Positive and negative predictive values were 89.2% and 99.4%, respectively. CONCLUSIONS: Our data suggest that the proposed ß-TP interpretation algorithm is a valuable tool for the diagnosis of CSF leakage in the clinical practice.

Cellular response on Auger- and Beta-emitting nuclides: human embryonic stem cells (hESC) vs. keratinocytes.

PURPOSE: We studied the response of human embryonic stem cells (hESC) to the ß-emitter (131)I, which affects the entire cell and to the Auger electron emitter (125)I-deoxyuridine ((125)I-dU), primarily affecting the deoxyribonuleic acid (DNA). The effects were also studied in keratinocytes as a prototype for somatic cells. METHODS: HESC (H1) and human keratinocytes (HaCaT, human) were exposed to (125)I-dU (5 × 10(-5) - 5 MBq/ml) and (131)I-iodide (5 × 10(-5) - 12.5 MBq/ml) and apoptosis was measured by DNA-fragmentation. Cell morphology was studied by light microscopy and electron microscopy. Transcriptional profiling was done on the Agilent oligonucleotide microarray platform. RESULTS: Auger-process induced no apoptosis but a strong transcriptional response in hESC. In contrast, HaCaT cells showed a pronounced induction of apoptosis but only a moderate transcriptional response. Transcriptional response of hESC was similar after (125)I-dU and (131)I treatments, whereas HaCaT cells expressed a much more pronounced response to (125)I-dU than to (131)I. A striking radiation-induced down-regulation of pluripotency genes was observed in hESC whereas in keratinocytes the enriched gene annotations were related primarily to apoptosis, cell division and proliferation. CONCLUSIONS: Human embryonic stem cells respond to ionizing radiation by (125)I-dU and (131)I in a different way compared to keratinocytes. Transcriptional response and gene expression appear to facilitate an escape from programmed cell death by striking a new path which probably leads to cell differentiation.