Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique.

Sphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.

Pre-caruncular approach to the medial orbit and landmarks for anterior ethmoidal artery ligation: a cadaveric study.

OBJECTIVE: In epistaxis and skull base surgery, the anterior ethmoidal artery sometimes needs to be ligated. We describe a novel, quick and scar-free surgical technique to ligate this artery with salient landmarks allowing rapid identification. PATIENTS AND METHODS: Twenty medial orbital walls from 10 randomly selected fresh-frozen, non-formalinised cadaver heads were examined. Dissection was performed by a pre-caruncular external approach to expose the AEA in all cases. RESULTS: The Horner's muscle and nasion, two salient landmarks, have been identified for use during the pre-caruncular approach. DISCUSSION/CONCLUSION: The pre-caruncular approach is a novel combined open and endoscopic surgical approach to the anterior ethmoidal artery. It is a simple, quick and scar-free technique. The identification of the artery is easy when using the two anatomic landmarks we describe in our study, that is Horner's muscle and the nasion.

Disease Management Project Breast Cancer in Hesse - 5-Year Survival Data: Successful Model of Intersectoral Communication for Quality Assurance.

Introduction: The Disease Management Project Breast Cancer (DMP Breast Cancer) was first launched in Hesse in 2004. The project is supported by the health insurance companies in Hesse and the Professional Association of Gynaecologists in Hesse. The aim is to offer structured treatment programmes to all women diagnosed with breast cancer in Hesse by creating intersectoral cooperations between coordinating clinics, associated hospitals and gynaecologists in private practice who registered in the DMP programme. Method: Between 1 January 2005 and 30 June 2011, 13 973 women were enrolled in the DMP programme. Results: After data cleansing, survival rates were calculated for a total of 11 214 women. The 5-year overall survival (OS) rate was 86.3 %; survival rates according to tumour stage on presentation were 92.2 % (pT1) and 82.3 % (pT2), respectively. The impact of steroid hormone receptor status on survival (87.8 % for receptor-positive cancers vs. 78.9 % for receptor-negative cancers) and of age at first diagnosis on survival (≤ 35 years = 91 %) were calculated. Conclusion: The project showed that intersectoral cooperation led to significant improvements in the quality of treatment over time, as measured by quality indicators and outcomes after treatment.

Endoscopic resection of skull base tumours utilising the ultrasonic dissector.

OBJECTIVE: We report the use and benefits of the ultrasonic dissector in the resection of difficult skull base lesions. METHOD: Five case reports are presented, and the utilisation of ultrasonic dissectors in otorhinolaryngology is reviewed. RESULTS: The ultrasonic dissector was found to be a useful tool during the endoscopic resection of poorly accessible skull base tumours. Safe dissection and complete removal of all five lesions were achieved without any vascular injury. To our knowledge, this is the first report of the use of the ultrasonic dissector for the resection of sinonasal and skull base tumours. CONCLUSION: The ultrasonic dissector was found to be particularly useful during the endoscopic transnasal approach to the petrous apex. During minimally invasive endonasal surgery, benefits include the length of the instrument, speed and precision of dissection, and low risk of vascular injury.

Peroral drainage of post-traumatic sialocoeles: report of three cases.

OBJECTIVE: To discuss the technique and outcome of this simple procedure and the management of post-traumatic parotid sialocoeles, and to review the literature regarding this condition. CASE REPORT: We report the successful surgical treatment, by peroral drainage, of three patients with post-traumatic parotid sialocoele resistant to conservative management. DISCUSSION: We discuss the method and outcome of the surgical procedure performed, along with the causes, presentation and management of parotid sialocoele. CONCLUSION: Correct initial management of a parotid duct injury may prevent the formation of a sialocoele. When conservative treatment of post-traumatic parotid sialocoele fails, we advocate the surgical technique described in this report as it is effective, simple and carries minimal risk to the patient.

Alcohol sclerotherapy of human immunodeficiency virus related parotid lymphoepithelial cysts.

OBJECTIVE: The aim of the study was to determine the effectiveness of alcohol sclerotherapy in patients with human immunodeficiency virus related salivary gland disease. STUDY DESIGN: Prospective study investigating the effectiveness of alcohol as a sclerosing agent. SETTING: Tertiary referral hospital. PATIENTS: Eleven human immunodeficiency virus positive patients with benign lymphoepithelial cysts were included in the study, from July 2005 to September 2006. INTERVENTIONS: Alcohol sclerotherapy was performed under local anaesthesia, with alcohol infiltrated into the benign lymphoepithelial cysts. RESULTS: Alcohol injection sclerotherapy proved to be an effective, simple, cheap, ambulatory procedure for patients who did not qualify for antiretroviral treatment.

Revisiting the risks involved in using homograft ossicles in otological surgery.

Despite the fact that cartilage, cortical bone and corneal homograft tissue is still widely used in South Africa and that there has never been a reported case of human immunodeficiency virus or Creutzfeldt-Jakob disease infection transmission via this route, otolaryngologists are still reluctant to use homograft ossicles. In third world countries, such as South Africa, where ossicular prostheses are not always readily available due to financial constraints, the question arises as to whether we should be reconsidering the use of homograft ossicles. This review examines the risk of developing Creutzfeldt-Jakob disease or acquiring human immunodeficiency virus following the use of homograft ossicles during ossicular reconstruction, and discusses sterilization techniques that have proven effective in eradicating the human immunodeficiency virus and prions. For decades, homograft ossicles have been used worldwide in otological surgery, especially in patients lacking suitable autograft ossicles. There has never been a reported case of transmission of the human immunodeficiency virus, and no cases of transmissible spongiform encephalopathy have been reported in the literature after otological surgery involving only the use of homograft ossicles. There have only been two documented otological cases of Creutzfeldt-Jakob disease; these involved the use of cadaveric dura mater and pericardium for tympanic membrane grafting. The human immunodeficiency virus is easily inactivated by simple sterilisation techniques, and there is a statistically insignificant risk of transmitting this virus if proper sterilisation protocols are followed.

Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery.

OBJECTIVE: To demonstrate the importance of pre-operative ear, nose and throat assessment in patients undergoing endoscopic, transsphenoidal surgery for pituitary tumours. CASE REPORTS: Literature pertaining to the pre-operative otorhinolaryngological assessment and management of patients undergoing endoscopic anterior skull base surgery is sparse. We describe two cases from our series of 59 patients undergoing endoscopic pituitary surgery. The first case involved a young male patient with a large pituitary macroadenoma. His main complaint was visual impairment. He had no previous history of sinonasal pathology and did not complain of any nasal symptoms during the pre-operative neurosurgical assessment. At the time of surgery, a purulent nasal discharge was seen emanating from both middle meati. Surgery was abandoned due to the risk of post-operative meningitis, and postponed until the patient's chronic rhinosinusitis was optimally managed. The second patient was a 47-year-old woman with a large pituitary macroadenoma, who presented to the neurosurgical department with a main complaint of diplopia. She too gave no history of previous nasal problems, and she underwent uneventful surgery using the endoscopic, transnasal approach. Two weeks after surgery, she presented to the emergency unit with severe epistaxis. A previous diagnosis of hereditary haemorrhagic telangiectasia was discovered, and further surgical and medical intervention was required before the epistaxis was finally controlled. CONCLUSIONS: Pre-operative otorhinolaryngological assessment is essential prior to endoscopic pituitary or anterior skull base surgery. A thorough otorhinolaryngological history will determine whether any co-morbid diseases exist which could affect the surgical field. Nasal anatomy can be assessed via nasal endoscopy and sinusitis excluded. Computed tomography imaging is a valuable aid to decisions regarding additional procedures needed to optimise access to the pituitary fossa.

[Long-term locally-recurrent melanoma]. / Langfristig lokal rezidivierendes malignes Melanom.

Malignant melanoma is a highly malignant skin tumor with a widely variable individual course. Currently, approximately 75% of German patients can be cured of malignant melanoma by early diagnosis and excision, while more than 20% die of distant metastases of the melanoma. In contrast, there are single cases of long-term locally recurrent melanomas with neither complete cure nor development of distant metastases. We report on a female patient with a nevus-associated melanoma who was treated in 1968 with X-ray radiation (Dermopan, 100 Gy) with curative intent. In the following 31 years, the patient developed four phases of in-transit and satellite metastases in a zosteriform pattern as well as ilioinguinal lymph node metastasis. Since 1999, the patient has been free of recurrence. Besides the unusual biological features of this case, this report reflects the changes of paradigms in the therapy of melanoma over the last forty years.

[Congenital melanocytic nevi]. / Kongenitale melanozytäre Nävi.

Congenital melanocytic nevi are benign skin tumours with a population-based prevalence of 1-6%. They run an increased life-time risk of transformation into malignant melanoma. Additionally, they can be associated with an involvement of the leptomeninges (neurocutaneous melanosis), and may cause considerable cosmetic and psychic problems. In contrast to the past, the risk of congenital melanocytic nevi developing into melanoma is now regarded as well-established. Thus, excision is recommended whenever possible. Large lesions which do not allow complete excision should be treated by dermabrasion within the first weeks of life.

[Results of a randomized polychemotherapy study in malignant melanoma]. / Ergebnisse einer randomisierten Polychemotherapiestudie beim malignen Melanom.

A polychemotherapy (DTIC, vincristine, ftorafur, hydroxycarbamide) devised with reference to the results of short-term sensitivity tests in cell culture is compared with single-agent chemotherapy with DTIC in malignant melanoma. Effectiveness was investigated in a randomized prospective study in cases of high-risk melanoma in clinical stage I, in clinical stage II after lymphadenectomy and in clinical stage III after tumour debulking. The results recorded allow no positive effects of either form of chemotherapy in stage I disease compared with surgical treatment only in a control group. In contrast, a statistically significant advantage of the polychemotherapy was noted in stage II compared with a control group. There was no significant difference in the results of treatment between the two forms of chemotherapy in stage III. No complete remissions of long duration have been achieved.

[Model antigens and their significance for occupational dermatology]. / Modellantigene und ihre Bedeutung für die Arbeitsdermatologie.

By means of epicutaneous tests we studied the contact hypersensitivity to DNP-amino acids in individuals sensitized to dinitrochlorobenzene (DNCB). We found a high incidence of positive skin responses to DNP-glycine, di-DNP-L-cystine, and DNP-L-alpha-alanine, but only in some cases DNP-beta-alanine induced skin reactivity. The results are discussed both in connection with the influence of varying molecular sizes and chemical structure on the immunological reactivity and the possibility to develop a beta-alanine containing protective ointment against protein-reactive haptens.

[Contact eczema caused by pesticides in East Germany]. / Kontaktekzem durch Pestizide in der Deutschen Demokratischen Republik.

19 allergic, occupational contact eczemas and 1 irrative contact dermatitis caused by pesticides from 1985-86 in the GDR are described. The 20 casuistic reports are supplemented with data concerning age, sex, exposure time, patch-test results, occupation site and dermatological details. The following pesticides were determined: maneb, zineb, mancozeb, propineb, thiram, demephion, dimethoate, propachlor, metham-Na, benomyl, chloralhydrate with chloralmethylhalbacetal, carbaryl, dinocap captan, phenyl-Hg-acetate and trichlodinitrobenzene. Each individual case adhered to the recommended test concentration for skin tests. Contact eczemas brought about by the pesticides demephion and trichlordinitrobenzene have not yet to be described. Those working in gardening seem to be particularly prone.

[The quantitative immunochemical determination of specific antibodies against Candida albicans within the scope of immunological testing in the malignant melanoma (author's transl)]. / Die quantitative immunchemische Bestimmung spezifischer Antikörper gegen Candida albicans im Rahmen eines Immunstatus beim malignen Melanom.

Precipitating antibodies against a polysaccharide antigen from Candida albicans were in the human serum determined quantitatively by the aid of a reversed radial immunodiffusion technique. The gel, therewith, contained the antigens, whilst into the gel's punching holes the serum specimens and the calibrated standards were filled in. Amplifying examinations of the course in patients suffering from malignant melanoma, the findings of the methods used hitherto were compared within the scope of an immunological status (in vivo-skin testing by dinitrochlorobenzene, Candida antigen, trichophytin, and tuberculin, precipitation test after Ouchterlony, immunofluorescence-optical evidence of Candida antibodies as well as determination of the Candida antibodies. In contrast to the hitherto available qualitative or semi-quantitative methods evidencing humoral antibodies, we consider the feasibility of simply workable quantitative determinations of antibodies to be an enrichment of the scale of methods. The reversed Mancini technique, simultaneously, is appropriate to determine specific antibodies against other diagnostically relevant antigens, so far as precipitating antigen/antibody complexes are formed. Therewith, commercially available testing kits could favour the standardization.

[Cancer immunotherapy in dermatological view (author's transl)]. / Immuntherapie des Krebses aus der Sicht des Dermatologen.

The present paper summarizes clinical possibilities of postoperative cancer immunotherapy. Our therapeutic schedule in patients with malignant melanoma consists of BCG by using scarification-technique in randomized groups. Regarding the local treatment of melanoma immunotherapy with DNCB is shown to be of temporary benefit in some cases. But the current state of our knowledge on immunology of human tumours does not allow to perform an immunotherapy generally.