Prediction of outcome by lymph node ratio in patients with parotid gland cancer.

OBJECTIVE: Lymph node ratio (LNR) has been shown to be an independent predictor of recurrence risk and survival in different entities of carcinoma. METHODS: In this retrospective chart review, 128 patients with parotid gland cancer (PGC) subsequently treated by primary surgery were included. About 64% (n = 82) of these patients were additionally treated with adjuvant radiotherapy. Five-year overall survival rates were determined by subgroups based on LNR value. RESULTS: Lymph node ratio was found to be significantly associated with overall survival rate (P < 0.001). Using univariate analyses, pathological tumour-node-metastasis (TNM)-stage, UICC-stage grouping and extracapsular spread were found to be significant predictors of overall survival (P < 0.001). However, with a multivariate analyses, LNR remained the only independent predictor of overall survival (P = 0.043). CONCLUSIONS: After surgery for PGC, evaluation of the neck using LNR was found to reliably stratify the overall survival rate.

Voluntary or involuntary? A neurophysiologic approach to functional movement disorders.

Patients with functional movement disorders (FMD) experience movements as involuntary that share fundamental characteristics with voluntary actions. This apparent paradox raises questions regarding the possible sources of a subjective experience of action. In addition, it poses a yet unresolved diagnostic challenge, namely how to describe or even quantify this experience in a scientifically and clinically useful way. Here, we describe recent experimental approaches that have shed light on the phenomenology of action in FMD. We first outline the sources and content of a subjective experience of action in healthy humans and discuss how this experience may be created in the brain. Turning to FMD, we describe implicit, behavioral measures that have revealed specific abnormalities in the awareness of action in FMD. Based on these abnormalities, we propose a potential, new solution to the paradox of volition in FMD.

Clinicopathological and immunohistochemical characteristics of surgically treated primary carcinoma of the nasal vestibule - an evaluation of 30 cases.

OBJECTIVES/HYPOTHESIS: Squamous cell carcinoma of the nasal vestibule (SCCNV) is a rare tumour entity. Treatment modality, particularly indication of neck dissection, is still a controversial subject of debate. We sought to evaluate the occurrence of lymph node metastases, the prognosis and the immunohistochemical characteristics of SCCNV. STUDY DESIGN: Retrospective cohort study. METHODS: This study included 30 consecutive patients with SCCNV treated with primary tumour resection and neck dissection in cases of suspicious lymph nodes between 2003 and 2013. According to therapeutical standard adjuvant radiotherapy or chemotherapy were applied in some cases. Clinicopathological data and immunohistochemical expression of CK5/6, EGFR, Ki-67, MMP-2, MMP-9, p53 and VEGFR were analysed. RESULTS: The median follow-up period was 47.1 months. Five-year disease-free (5-year DFS) and 5-year overall survival (5-year OS) were 91.7% and 92.3%. Five-year OS in low-grade tumours (G1, G2) was 100.0%, in high-grade tumours (G3) 75.0% (P = 0.028), respectively. We did not detect any lymph node metastases in the neck dissections. Overexpression of p53 showed a trend for better 5-year OS (p53-positive 100% versus p53-negative 77.8%, n.s.). We found a positive correlation between p53 and EGFR (P = 0.0001). There was no significant relationship between the expression rates of the markers and tumour stage and grading. CONCLUSIONS: We propose no prophylactic neck dissection in small-sized SCCNV. Subtile endoscopic follow-up and periodic ultrasound examination of the cervical lymph nodes after surgical treatment are recommended. Further evaluation of the p53- and EGFR-pathways might pave the way to identify possible molecular targets in an attempt to tailor tumour management.

[Diseases of the nose and paranasal sinuses in childhood]. / Erkrankungen der Nase und der Nasennebenhöhlen im Kindesalter.

Diseases of the pediatric nose and paranasal sinuses as well as neighboring anatomical structures encompass a variety of pathologies, especially of inflammatory nature. Congenital disease, such as malformations and structural deviations of the nasal septum, as well as systemic metabolic pathologies affecting the nose and sinuses, rarely require medical therapy from an Otolaryngologist. The immunological function of the mucosa and genetic factors play a role in the development of disease in the pediatric upper airway tract, especially due to the constantly changing anatomy in this growth phase. Disease description of the nose and nasal sinuses due to mid-facial growth must also take developmental age differences (infant, toddler, preschool, and school age) into account. Epidemiological examinations and evidence based studies are often lacking in the pediatric population. The wide range of inflammatory diseases of the nose and paranasal sinuses, such as the acute and chronic rhinosinusitis, the allergic rhinitis, and adenoid disease, play a role in the susceptibility of a child to infection. The susceptibility to infection depends on the pediatric age structure (infant, young child) and has yet to be well defined. The acute rhinosinusitis in children develops after a viral infection of the upper airways, also referred to as the "common cold" in the literature. It usually spontaneously heals within ten days without any medical therapy. Antibiotic therapy is prudent in complicated episodes of ARS. The antibiotic therapy is reserved for children with complications or associated disease, such as bronchial asthma and/or chronic bronchitis. A chronic rhinosinusitis is defined as the inflammatory change in the nasal mucosa and nasal sinus mucosa, in which the corresponding symptoms persist for over 12 weeks. The indication for CT-imaging of the nasal sinuses is reserved for cases of chronic rhinosinusitis that have been successfully treated with medication. A staged therapeutic concept is followed in CRS based on conservative and surgical methods. Nasal sinus surgery is considered nowadays as effective and safe in children. Based on the assumption that adenoids are a reservoir for bacteria, from which recurrent infections of the nose and nasal sinus originate, the adenoidectomy is still defined as a cleansing procedure in rhinosinusitis. 69.3% of the children had benefit from adenoidectomy. Comorbidities, such as pediatric bronchial asthma, presently play an even more important role in the therapy of rhinosinusitis; therefore, it is often wise to have the support of pediatricians. In western European countries 40% of children presently suffer from allergic rhinitis, in which pronounced nasal obstruction can cause disturbed growth in facial bones. An early therapy with SIT may prevent the development of bronchial asthma and secondary sensitization to other allergens. Therefore, SIT is recommended in treatment of allergic rhinitis whenever, if possible. The assessment of diagnostic tools is for the examiner not often possible due to the lack of evidence. Rhinosurgical approaches are often described in study reports; however, they lack the standard prospective randomized long-term study design required nowadays and can only be evaluated with caution in the literature.

Static compressive tracking.

This paper presents the Static Computational Optical Undersampled Tracker (SCOUT), an architecture for compressive motion tracking systems. The architecture uses compressive sensing techniques to track moving targets at significantly higher resolution than the detector array, allowing for low cost, low weight design and a significant reduction in data storage and bandwidth requirements. Using two amplitude masks and a standard focal plane array, the system captures many projections simultaneously, avoiding the need for time-sequential measurements of a single scene. Scenes with few moving targets on static backgrounds have frame differences that can be reconstructed using sparse signal reconstruction techniques in order to track moving targets. Simulations demonstrate theoretical performance and help to inform the choice of design parameters. We use the coherence parameter of the system matrix as an efficient predictor of reconstruction error to avoid performing computationally intensive reconstructions over the entire design space. An experimental SCOUT system demonstrates excellent reconstruction performance with 16X compression tracking movers on scenes with zero and nonzero backgrounds.

[Prognosis of surgically treated primary parotid gland cancer - an evaluation of 231 cases]. / Zur Prognose chirurgisch therapierter primärer Parotiskarzinome - eine Untersuchung an 231 Fällen.

We present our results on the prognosis of parotid gland cancer with the help of a group of patients who were treated in a standardised manner and received a long term follow-up.We retrospectively analysed the clinicopathological data of 231 patients with a surgically treated primary parotid gland cancer and calculated survival parameters. The mean follow-up time was 52 months.The 5- and 10-year overall survival rate was 74.2% and 66.9%. 70 patients got a locoregional recurrence, 18.6% of those even after more than 5 years. Initial facial nerve palsy was a significant negative prognostic indicator for the disease-free survival. The most frequent histological subtypes could be divided into 3 prognostic groups with significant differences in the survival. The pathological tumour stage was a prognostic indicator for a worse overall and disease-free survival. The pT-stage, the pN-stage and the existence of distant metastases were independent prognostic factors.The group of patients is mainly characterised by the large size, the standardised therapy and the long follow-up time. We could show that the facial nerve palsy is a severe negative prognostic factor. For practical purpose, the classification into 3 histological subgroups seemed to be of great help. This should be considered in patient follow-up. Due to the amount of late recurrences, we propose a follow-up time longer than 5 years. We propose standardized surgery including total parotidectomy in combination with neck dissection.

Topical therapy in anosmia: relevance of steroid-responsiveness.

OBJECTIVES/HYPOTHESIS: The use of steroids either systemically or topically is known as a common therapy in patients with anosmia. Nevertheless, investigations giving proof for the benefit of a topical therapy are very rare, and no prognostic factors are known. In our study, we for the first time evaluated the additional effect of a topical therapy not only with steroids but also with antibiotics after conventional pretreatment with oral steroids and propose the steroid-responsiveness of an anosmia as a prognostic factor. STUDY DESIGN: Retrospective design. METHODS: We analyzed the data of 299 patients with olfactory dysfunction. Eighty-nine underwent initial pretreatment with systemic steroids and presented data over a sufficient follow-up time. In a second step all these patients were given a topical treatment in a head down forward position, namely either budesonid alone or in combination with neomycin. Primary outcome parameter was the threshold, discrimination and identification (TDI) score. RESULTS: Initial therapy with oral steroids changed the TDI from 15.5 to 18.7 in the means (P < .001). In general, leaving away systemic steroids while applying local therapy did not led to a reduction of the TDI (P < .001). Dividing up the patients into those suffering from a steroid-responsive anosmia (SRA) and those without benefit from initial systemic steroids (non-SRA), the topical treatment led to a significant difference between the two groups with benefit toward the non-SRA group (P < .001). Regarding only the nonchronic rhinosinusitis anosmics, these findings became even more apparent. Furthermore, in non-SRA patients we found even better results with steroids in combination with neomycin as a topical therapy. In this group, the combined topical therapy elevated the TDI for +2.1 points whereas topical steroids alone raised it only for +1.0 point. CONCLUSIONS: The steroid-responsiveness of anosmia seems to be a relevant prognostic indicator for a significant benefit of a topical therapy in general. Within all patients, the effect of an initial systemic therapy could be maintained by the adjacent topical treatment whereas in non-SRA patients a topical therapy has a significant greater impact. Furthermore, antibiotics even seem to have an additional effect in this group. Different reasons, first of all an overwhelmed steroid resistance by additional antiinflammatory effects of antibiotics, e.g., the inhibition of apoptosis might play a role and are discussed.

Accessory parotid gland lesions: case report and review of literature.

There are numerous causes for chronic cheek swelling, including masseteric hypertrophy, lymphadenopathy, diffuse inflammatory changes and neoplasia. We report an unusual case of a recurrent swelling as the result of sialolithiasis of an accessory parotid gland, which lay isolated from the main parotid gland along the Stensen's duct. The calculi developed in the accessory salivary tissue whereas all major salivary glands presented without sialolithiasis. Clinical findings as well as imaging results are shown and surgical management and histopathology are discussed. Hereby, for the first time we report a case with multiple calculi in an accessory parotid gland removed via a standard parotid incision. Further to this, we give a comprehensive review of literature on accessory parotid gland lesions.

Nuclear survivin expression is associated with HPV-independent carcinogenesis and is an indicator of poor prognosis in oropharyngeal cancer.

The relationship between expression of the inhibitor of apoptosis protein survivin and the presence of high-risk human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OSCC) remains unclear. This also accounts for its role as a predictor of survival. Therefore, we conducted a multicentre retrospective study on 106 consecutive oropharyngeal cancer patients. Human papillomavirus sequences were detected by nested PCR protocols. Survivin and p16 expression as a surrogate marker for HPV status were analysed by immunohistochemistry. Sequences of high-risk HPV were detected in 29% of cases. Prominent cytoplasmatic expression of survivin was found in 58% of cases and nuclear expression of survivin was found in 19% of the survivin-positive tumours. Nuclear expression of survivin was significantly correlated with HPV-negative tumours (P=0.023) and with a poor disease-free survival rate with an estimated 3-year disease-free survival probability of 35% for tumours with nuclear expression of survivin vs 78% for tumours with non-nuclear expression of survivin (hazard ratio=8.264; 95% confidence interval (95% CI)=2.510-27.210; P<0.001). In multivariate analysis, p16 expression status as well as nuclear expression of survivin were strong independent and opposing prognostic indicators of disease-free survival (hazard ratio=0.068; 95% CI=0.005-0.892; P=0.041 and hazard ratio=15.975; 95% CI=2.377-107.360; P=0.004, respectively). Our data show that nuclear accumulation of survivin correlates with HPV-independent carcinogenesis and is an independent predictor of poor survival in patients with OSCC.

[Treatment of sensorineural hearing loss in acute viral otitis media with intratympanic dexamethasone and hyaluronic acid in comparison with intravenous therapy]. / Behandlung der Innenohrschwerhörigkeit bei akuter viraler Otitis media mittels intratympanaler Injektion von Dexamethason und Hyaluronsäure im Vergleich zur rheologischen Infusionstherapie.

BACKGROUND: Intratympanic dexamethasone with hyaluronic acid has shown to be an effective treatment of the inner ear damage in sudden hearing loss and Menière's disease. It is not known yet if the same applies to the toxic inner ear damage in acute viral otitis media. PATIENTS: Retrospectively, 26 patients who suffered from acute viral otitis media with sensorineural hearing loss were examined with regard to the improvement of their inner ear hearing loss. Twelve patients were treated with intravenous therapy only, consisting of hydroxyethyl starch, pentoxifylline and prednisolone. Fourteen patients additionally received intratympanic injections, consisting of dexamethasone and hyaluronic acid once acute inflammatory changes subsided. The inner ear hearing loss was evaluated by means of standard bone-conduction audiometry. RESULTS: Neither local nor systemic side effects of the intratympanic injections occurred. During treatment no significant difference in the improvement of bone-conduction thresholds in any frequency was seen between the two groups. CONCLUSIONS: Intratympanic injections of dexamethasone with hyaluronic acid do not result in any additional benefit on the sensorineural hearing loss in acute viral otitis media compared to intravenous therapy alone. A reason might be the post inflammatory changes of the round window membrane or the toxic nature of the acute viral infection affecting the inner ear.

Polarization instabilities in a two-photon laser.

We describe the operating characteristics of a new type of quantum oscillator that is based on a two-photon stimulated emission process. This two-photon laser consists of spin-polarized and laser-driven 39K atoms placed in a high-finesse transverse-mode-degenerate optical resonator and produces a beam with a power of approximately 0.2 microW at a wavelength of 770 nm. We observe complex dynamical instabilities of the state of polarization of the two-photon laser, which are made possible by the atomic Zeeman degeneracy. We conjecture that the laser could emit polarization-entangled twin beams if this degeneracy is lifted.

Prolonged analgesia and decreased toxicity with liposomal morphine in a mouse model.

Inadequate control of postoperative pain remains a major clinical problem. A reliable method of providing long-lasting postoperative analgesia with a single dose would be very useful. We synthesized a liposomal morphine formulation and compared it to free morphine with regard to duration of analgesia in the mouse. Analgesia was assessed after intraperitoneal injection using the tail-flick test. The systemic toxicity after administration of liposomal and free morphine was compared. The release rate of morphine from liposomes in vitro was also evaluated. The lethal intraperitoneal dose of free morphine in 50% of mice (LD50) was 400 mg/kg. The maximum safe (non-lethal) dose of free morphine was 130 mg/kg. The highest dose of liposomal morphine administered (1650 mg/kg) did not cause death in any animal. Duration of analgesia was significantly prolonged with the highest dose of liposomal morphine (21.5 +/- 5.3 h) compared to the maximum safe dose of free morphine (3.7 +/- 0.75 h), P < 0.01. In vitro experiments showed a slow release rate of morphine from the liposome depot. Prolonged analgesia and decreased systemic toxicity for liposomal morphine are explained by sustained release of morphine from the liposomal depot. These results suggest that liposomal narcotic formulations may provide prolonged analgesia with single-dose administration.

Clinical potency of calcium channel blockers in asthma may be related to their inhibition of receptor-mediated phasic responses in vitro.

The calcium channel blockers (CCB) have been clinically effective in exercise-induced asthma. The completeness of protection with the CCB might be related specifically to inhibition of Ca2+ influx or release. To examine this hypothesis, the rank order of potency of inhibition of the CCB, nicardipine, diltiazem and verapamil on the steady-state and kinetic parameters of the phasic and tonic responses to the muscarinic receptor agonist carbachol (10 microM) and KCl (40 mM) in the intact isolated guinea-pig trachea was determined. The Ca2+ channel agonist Bay K 8644 was also examined for its effects on intracellular Ca2+. Nicardipine abolished the KCl response at both 0.1 microM and 1 microM concentrations. The amplitude of the KCl response was inhibited equally by 1 microM diltiazem (61% inhibition) and 1 microM verapamil (68% inhibition). The rate constant of onset of the KCl response was similarly inhibited 60% by diltiazem and 66% by verapamil. Nicardipine abolished the carbachol phasic response at the 1 microM concentration. The amplitude of the phasic response was inhibited equally by 0.1 microM nicardipine (61.3% inhibition), 1 microM diltiazem (64.5% inhibition) and 1 microM verapamil (71% inhibition). The rate constant of decay of the phasic response was inhibited equally by 0.1 microM nicardipine (43% inhibition) and 1 microM diltiazem (29% inhibition). The rate constant of onset of the phasic response was unaffected by nicardipine, diltiazem and verapamil. Only 1 microM nicardipine inhibited the amplitude and rate constant of onset of the tonic response. The only effect of Bay K 8644 (1 microM) was to increase the phasic response amplitude. The CCB demonstrate a similar order of potency for inhibition of the phasic responses and clinical efficacy of the CCB in exercise-induced asthma (nicardipine > verapamil > diltiazem).(ABSTRACT TRUNCATED AT 250 WORDS)