Is ultraviolet exposure acquired at work the most important risk factor for cutaneous squamous cell carcinoma? Results of the population-based case-control study FB-181.

BACKGROUND: Squamous cell carcinoma (SCC) is one of the most frequent types of cancer constituting a significant public health burden. Prevention strategies focus on limiting ultraviolet (UV) exposure during leisure time. However, the relative impact of occupational and nonoccupational UV exposure for SCC occurrence is unclear. OBJECTIVES: To investigate the association between occupational and nonoccupational UV exposure for SCC in a multicentre population-based case-control study hypothesizing that high occupational UV exposure increases the risk of SCC. METHODS: Consecutive patients with incident SCC (n = 632) were recruited from a German national dermatology network. Population-based controls (n = 996) without history of skin cancer were recruited from corresponding residents' registration offices and propensity score matched to cases. Lifetime UV exposure, sociodemographic and clinical characteristics were assessed by trained physicians. Occupational and nonoccupational UV exposure doses were estimated by masked investigators using established reference values. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were assessed using conditional logistic regression adjusting for relevant confounders. RESULTS: Total solar UV exposure was significantly associated with increased SCC. The OR for high (> 90th percentile) vs. low (< 40th percentile) and high vs, moderate (40-59th percentile) occupational UV exposure was 1·95 (95% CI 1·19-3·18) and 2·44 (95% CI 1·47-4·06) for SCC. Adjusting for occupational UV exposure, nonoccupational UV exposure was not significantly related to SCC incidence. Dose-response relationships were observed for occupational but not for nonoccupational solar UV exposure. CONCLUSIONS: Solar occupational UV exposure is a major determinant of incident SCC. Our findings indicate that prevention strategies should be further expanded to the occupational setting.

[The risks of autogenous cartilage grafting in laryngotracheal reconstruction in adults]. / Risiko des autogenen Knorpeltransplantats bei laryngotrachealer Rekonstruktion bei Erwachsenen.

BACKGROUND: Laryngotracheal reconstruction with autogenous rib cartilage graft has become a well established surgical method for the repair of subglottic and glottic laryngotracheal stenoses in infants and children. There are far fewer reports on the application of this method in adult patients. In particular, detailed observations of the healing behaviour of autogenous adult rib cartilage grafts are lacking. MATERIAL AND METHOD: The course of disease in five adult female patients (age 25-47 years) who underwent one- or two-stage laryngotracheal reconstruction with rib cartilage grafts are reported. RESULTS: Primary healing was observed in the youngest patient (25 years) only. In the other four patients the cartilage graft had to be partly removed 4-6 weeks postoperatively due to partial necrosis, followed by open wound treatment. As a result of these measures a sufficiently large laryngotracheal lumen could be achieved in all cases. DISCUSSION: Partial ossification of the adult rib cartilage was considered the reason for the observed healing difficulties. Endoscopic follow-up showed that epithelialization of the free endolaryngeal surface of the cartilage graft, i.e. graft healing, takes at least 3 months. Therefore, close endoscopic follow-up during this period appears indispensable.

[Facial swelling caused by small cell lung cancer: a rare differential diagnosis of angioedema]. / Gesichtsschwellung bei kleinzelligem Bronchialkarzinom: Eine seltene Differenzialdiagnose des Angioödems.

Non-inflammatory swelling in the head and neck area are usually caused by allergic angioedema. However, other differential diagnoses must always be considered. Superior vena cava syndrome is a rare differential diagnosis of angioedema. Since we treated two such patients within only a few weeks of one another with the initial supposition of an ACE inhibitor-induced angioedema, but who ultimately proved to have lung cancer, we would like to draw attention to this disease pattern.

[Surgical management of inverted papillomas of the nose and paranasal sinuses]. / Zum chirurgischen Behandlungskonzept bei invertierten Papillomen der Nase und Nasennebenhöhlen.

INTRODUCTION: Inverted papillomas require radical resection because of their high recurrence rate and expansive growth and the risk of malignant degeneration. Since the late 1980s surgical resection has been performed predominantly as an endoscopy-/microscopy-aided procedure through an endonasal approach. The extranasal approach is only used in the case of papillomas in unusual locations or ones that have expanded to an exceptional degree. The goal of the present study was a comparative evaluation of the results of this relatively new treatment strategy and of external sinus surgery in our own patients, with particular reference to the recurrence rate. PATIENTS AND METHODS: Since 1989 a total of 80 patients have undergone surgery for inverted papilloma and have been followed up at regular intervals by means of endoscopic examinations. In any patients with a recurrence the revision operation was carried out through an extranasal approach when the papilloma was in the anterior or laterocaudal maxillary sinus or in the frontal sinus; in all other cases an endonasal approach was used for the revision surgery. The mean period of follow-up was 43 months (range 15 months to 16years). RESULTS: In most patients (n=64, 80%) the endonasal surgical approach was used for the primary surgical treatment, while in 16 patients (20%) an extranasal approach was used initially. In 2 patients (2.6%) a squamous cell carcinoma was discovered adjacent to the papilloma. These two therapeutic special cases were not considered evaluable in the analysis of recurrences. Recurrences were seen in 14 patients (17.9%, n=78), in 11 patients after endonasal surgery (17.5%, n=11) and in 3 (20%, n=15) after extranasal resection. The majority of recurrences developed in patients with T3 papillomas. CONCLUSIONS: The recurrence rates observed after endonasal resection are comparable to those after extranasal surgery. Thus, a primary endonasal approach does not mean any prognostic disadvantage. This approach should therefore be given preference over extranasal approaches whenever possible, because there are fewer side-effects and recovery is faster than after extranasal surgery.

[Patients' satisfaction after nasal septal and turbinate surgery. Results of a questionnaire]. / Ergebnisse einer Umfrage zur Patientenzufriedenheit nach Nasenseptumplastik und Muschelbehandlung.

INTRODUCTION: Regarding the satisfaction of patients efficiency and outcome of surgery on the nasal septum and the turbinates regularly is the topic of controversial discussion and occasionally some health authorities doubt there is an indication for these procedures in general. Subjective and objective evaluation of surgical outcome do not necessarily match in all cases. METHODS: A standardized questionnaire was sent to patients having undergone surgery on the nasal septum and the turbinates 33-45 months ago at a university hospital and a non-university hospital. Topics (10 all together) were e. g.: nasal aeration, sense of smell, rhinorrhea, snoring, general condition. Statistic significance of each parameter was verified. RESULTS: 138 questionnaires were reviewed. 82% of the candidates reported better aeration of the nose after surgery. 71% stated to have benefited from the operation. A relevant positive effect on snoring, rhinorrhea, headache and sense of smell could not be proved. The results did no different whether surgery was performed at a university hospital or at a non-university-hospital. Older patients seem to profit more from the procedure than younger ones. DISCUSSION: The survey clearly shows, that surgery on the nasal septum with turbinoplasty has a positive effect on the nasal aeration and the general condition. Therefore its performance is well justified when after careful verification of the pre-conditions the indication for surgery is given.

[Electron microscopic studies of the rabbit nasal mucosa after short-term application of naphzoline nitrate]. / Elektronenmikroskopische Untersuchungen der Nasenschleimhaut des Kaninchens nach kurzzeitiger Applikation von Naphazolinnitrat.

BACKGROUND: Vasoconstricting nasal drops are applied frequently. Especially early ultrastructural alterations of the vessels were not examined up to now in animal models. Our goal was the systematic investigation of the submucosal vessels and the epithelium after topic application of naphazoline nitrate (Privin) in an animal model. METHODS: Three times daily over 6 days 3 ml of 0.1% naphazoline nitrate solution (Privin) were instilled into the right nasal cavity of 5 rabbits. At the 7th and 14th day an incisional biopsy of the lower nasal turbinate was carried out in ketamine/rompun anesthesia. RESULTS: In the naphazoline group the capillaries showed an edematous endothelium with narrowed lumina. Thrombosis of the arterioles were frequently observed. The more cubic epithelial cells had deciliated areas with microvilli. Venules, submucosal glands and the surrounding connective tissue was normally configurated. Analogous findings were also observed after 2 weeks. CONCLUSIONS: The disturbance of the microcirculation shows impressive endothelial alterations. These structural changes can result in nonreversible mucosal damages. A regeneration time of more than 1 week is assumable. Our results should be considered critically in order to prevent damages of the nasal mucosa.

[Hyperacusis after tympanoplasty]. / Hyperakusis nach Tympanoplastik.

A case of hyperacusis after tympanoplasty is presented. A 62-year-old woman experienced unilateral conductive hearing loss for about 60 years after antrotomy in infancy. Neurological or otoneurological symptoms were not evident. Tympanotomy showed a missing incus with discontinuity of the chain. Reconstruction was performed by interposition of a partial ossicular replacement prosthesis (PORP). The postoperative audiogram revealed minimal perceptive hearing loss in the high-frequency field in the operated ear. Several weeks after middle ear surgery, the patient complained of hyperacusis on the operated side, which persisted for more than 2 years. To alleviate the unpleasant sensations, an ear plug was used by the patient. In spite of the asymmetric hearing loss, no late onset auditory deprivation could be diagnosed. The pathophysiological causes of the hyperacusis have not yet been clarified. Possible reasons are discussed.

Immunoelectron microscopic demonstration of the membrane proteases aminopeptidase N/CD13 and dipeptidyl peptidase IV/CD26 in normal and neoplastic renal parenchymal tissues and cells.

Aminopeptidase N (APN, CD13) and dipeptidyl peptidase IV (DPP IV, CD26) are transmembrane ectoenzymes occurring in a wide variety of cells. They are involved in tumour cell invasion and the formation of metastases. A basis for further information about these enzymes is the exact ultrastructural localization in normal and malignant cells. In this paper, we demonstrate the precise subcellular localization of the membrane peptidases APN and DPP IV on the cell surfaces in renal tissues, renal cell carcinoma, cultured renal parenchymal cells and cultured renal carcinoma cells. Using cryo-ultramicrotomy of weakly fixed tissues and cells in combination with indirect immunogold labelling, both membrane peptidases were detectable on the external cell surfaces. They showed different ultrastructural expression patterns. Both membrane peptidases were abundantly labelled on the external cell surfaces of human kidney proximal tubular cells. The expression pattern of APN/CD13 and DPP IV/CD26 in single labelling was confirmed by a successive double labelling technique. The immunolabelling of CD13 on cultured renal parenchymal cells showed a stronger expression then in cells in vivo, but CD26 could not be found. In renal cell cancer (mixed clear cell/chromophilic, poorly differentiated and clear cell type, moderately differentiated) CD13 and CD26 were labelled as in benign renal tissue, but CD26 appeared overexpressed. On the renal carcinoma cells Caki-1 and Caki-2, only one of the two peptidases could be found. CD13 was present non-homogeneously in Caki-1, where the enzyme appeared to form clusters. When CD26 on the cultured renal carcinoma cells Caki-2, is compared with renal proximal tubular cells and renal carcinoma cells in tissue sections, a reduced expression is observed. CD13 was not detected in Caki-2, and CD26 was not found in Caki-1. These small changes on the cell surfaces can only be detected by electronmicroscopic methods. The differences in the distribution of APN/CD13 and DPP IV/CD26 in normal and malignant cells are discussed in connection with literature. Further investigations, especially labelling studies on other neoplastic tissues and cells, will be necessary in order to explain the precise role these membrane peptidases in malignancies.

Expression patterns of the ectopeptidases aminopeptidase N/CD13 and dipeptidyl peptidase IV/CD26: immunoultrastructural topographic localization on different types of cultured cells.

Aminopeptidase N/CD13 and dipeptidyl peptidase IV/CD26 are widespread membrane-bound peptidases involved in fundamental biological processes. Using cryo-ultramicrotomy of cultured cells followed by indirect immunogold labelling, both enzymes appeared to be strongly and regularly labelled on the cell surfaces of human synovial fibroblasts, T-lymphocytes and colon carcinoma cells Caco-2. In the cytoplasm of the synovial fibroblasts gold-labelled vesicle-like structures were found, which we consider to be potential transport vesicles. An abundant and regular expression of CD13 was detected on cultured renal parenchymal cells. On the renal carcinoma cell line Caki-1 cells we found a low, non-homogeneous and clustered CD13-labelling. On cultured renal parenchymal cells and the Caki-1 cells CD26 could not be observed. The expression pattern of CD26 on renal carcinoma cell line Caki-2 cells showed also a slightly clustered distribution. A low density CD26-labelling was present on the squamous cell carcinoma cell line UM-SCC-22B. CD13 was absent in Caki-2 and UM-SCC-22B cells. The presence of both enzymes on the cultured cells enables their ultrastructural investigation under different growth conditions and their involvement in cell-cell interactions. For this purpose, however, further investigations are necessary.

Immunoelectron microscopic single and double labelling of aminopeptidase N (CD 13) and dipeptidyl peptidase IV (CD 26).

Using ultrathin cryosections and immunogold labelling, aminopeptidase N (CD 13) and dipeptidyl peptidase IV (CD 26) were localized on the luminal side of the brush border membrane of proximal tubular cells in human kidney as well as of enterocytes from rat small intestine. Furthermore, both enzymes could be detected on the cell surface of human T lymphocytes and especially aminopeptidase N on human synovial fibroblasts. Gold labelled vesicular structures were also found in the cytoplasm in the apical part of renal proximal tubular cells and synovial fibroblasts. In human kidney the colocalization of the two membrane antigens was possible by using several double labelling methods.