[Treatment of allergic rhinitis: update 2005]. / Therapie der allergischen Rhinitis. Mannschaftsaufstellung für die Allergiesaison 2005.

Potential approaches to the treatment of allergic rhinitis are the avoidance of allergens and medication with chromone compounds, antihistaminics and glucocorticosteroids. The sole causally effective treatment is specific immunotherapy. Leukotriene receptor antagonists, anti-IgE antibodies and monoclonal CD-4-molecules, as also soluble cytokine receptors are potential therapeutic options, the value of which currently remains unknown.

Tumors of the nasopharynx and adjacent areas: MR imaging with Gd-DTPA.

The purpose of this study was to describe our experience with Gd-DTPA-enhanced MR imaging in the evaluation of the most common nasopharyngeal tumors. Forty-two patients with tumors of the nasopharynx and adjacent spaces had MR imaging before and after IV injection of Gd-DTPA. Images were obtained with a 1.0-T superconducting magnet imaging system in transverse, coronal, and sagittal planes with T1- and T2-weighted sequences. MR images were compared with CT scans and tumor histology. The studies were categorized by using a grading system with grades ranging from unsatisfactory (grade 0) to optimal (grade 3). Contrast-enhanced MR enables better identification of small anatomic details such as both palatini muscles and the pharyngobasilar fascia. MR after Gd-DTPA was superior to CT in all cases except for tumors of the maxillary sinuses. MR with Gd-DTPA is recommended for tumors that are small and difficult to detect on the initial nonenhanced MR examination or that show subtle infiltrations. Because of the increased cost and longer examination time, MR with Gd-DTPA does not need to be done when large tumors are well delineated.

MR characteristics of primary extramedullary plasmacytoma in the head and neck.

PURPOSE: To define MR characteristics of primary extramedullary plasmacytoma in the head and neck using a variety of plain and contrast-enhanced MR protocols. METHODS: Six patients with primary extramedullary plasmacytoma in the head and neck were examined clinically and with MR imaging at 1.5 T. The morphologic appearance and signal intensities of the lesions were analyzed and the results of the imaging findings were compared with histopathologic findings. RESULTS: Qualitative analysis showed that five lesions were oval and sharply demarcated without signs of infiltration; the other lesion filled the parapharyngeal space bilaterally. On t2-weighted sequences, the lesions had moderate signal intensity. On plain T1-weighted sequences, the tumors were isointense or slightly hyperintense with respect to surrounding muscles; after administration of contrast medium, four lesions notable enhancement, with distinct central inhomogeneity. CONCLUSION: Although morphologic features or evidence of contrast enhancement do not assure certain diagnosis of extramedullary plasmacytoma, these MR imaging characteristics should prompt the radiologist to include this rare lesion in the differential diagnosis.

Basic fibroblast growth factor in serum and urine of patients with head and neck cancer.

Between 1996 and 1997 serum and urine levels of basic fibroblast growth factor (b-FGF) in patients with head and neck cancer were measured to answer the following questions: i) Are increased levels of b-FGF in serum and urine detectable in patients with malignant head and neck tumors? ii) Do these parameters correlate with tumor stage and differentiation of tumors? iii) Is there an association between growth behaviour (local or metastatic growth) and b-FGF levels in serum and/or urine? Eighty-nine patients with head and neck cancer as well as 45 patients with diseases unrelated to cancer were investigated. Detectable levels of b-FGF were found in the serum and urine of patients with malignant head and neck tumors. In addition, there was a significant correlation between tumor size and b-FGF levels in either serum or urine. No association of b-FGF concentrations with degree of histologic differentiation and tumor growth behaviour was observed. The results of this study demonstrate that b-FGF levels are elevated in serum and urine of patients with head and neck cancer. These findings suggest an involvement of b-FGF in the formation of solid tumors.

The role of fenestrated vessels for the secretory process in the nasal mucosa: a histological and transmission electron microscopic study in the rabbit.

Both nasal glands and nasal vessels are supposed to be responsible for the humidification of inhaled air. After previous studies on the vasculature of the nasal septal mucosa in the rabbit, we examined vessels of the anterior concha in order to find a morphological equivalent to explain the role of endonasal vasculature in the secretory process of this tissue. The main findings of our study include the detection of fenestrated endothelial walls of both capillaries and venous sinuses located underneath and directly adjacent to the basal cell layers of the epithelium. The same phenomenon-fenestrated vessels underneath the epithelium with the fenestrated parts facing the epithelial cells-has been described in other parts of the body and has been called "polar differentiation." In accordance with the interpretations of other authors, we conclude that these features are responsible for the regulation of endonasal fluid exchange.

Electron-microscopic observations on the muscular coat of swell bodies in human nasal mucosa.

Morphology and function of so-called nasal "swell bodies" or "cavernous tissue" have been studied by many investigators during the past 140 years. However, many details of this interesting and peculiar tissue remained unsolved, even though this vascular system plays an important role in a variety of rhinologic disorders. The present study describes electron-microscopic details of the muscular coat of the different venous structures that form human nasal swell bodies. The specimens were taken from patients requiring removal of conchal mucosa and septoplasty; semithin and ultrathin sections were obtained and examined with the optical and electron microscopes. The histologic evaluation showed differences in the venous wall structure depending on the location of the vessels. The muscular layers were significantly thinner in those parts of the swell bodies located adjacent to the epithelium. Electron-microscopic studies enabled us to determine the cytoplasmic components of smooth muscle cells, i.e., thin filaments, glycogen granules, caveolar plasmalemmal areas, cytoplasmic dense bodies (CDB), and membrane-associated dense bodies (MADB). Another interesting feature was the varying appearance of the basal lamina of smooth muscle cells of the cavernous tissue. Based on the findings of the present study, the morphologic peculiarities of nasal swell bodies are compared and discussed with the appropriate literature. Further immunohistochemical and molecular-biological studies will have to be performed to understand the complex functional mechanism of this unique vascular system.

Ho:YAG laser treatment of hyperplastic inferior nasal turbinates.

OBJECTIVES: Although preliminary studies about the successful use of the Ho:YAG laser in nasal turbinate surgery have been reported, no clinical study has been performed on this procedure. The aim of this prospective clinical study was to assess the long-term effect of Ho:YAG laser in the treatment of hyperplastic inferior nasal turbinates. METHODS: Eighty-five patients with nasal obstruction who did not respond to conservative medical treatment were treated with a pulsed Ho:YAG laser (wavelength of =2080 nm). Fifty-two of these patients were included in this clinical study and were followed for 1 year. RESULTS: Within the first 2 weeks, nasal obstruction was correlated to the extent of nasal crusting. Six months after laser treatment, the mucociliary function test showed no variation compared with the preoperative measurements. One year after laser treatment 77% of the patients demonstrated improved nasal airflow on rhinomanometry and questionnaire. CONCLUSIONS: Ho:YAG-laser treatment of hyperplastic turbinates can be performed as outpatient surgery under local anesthesia and offers controllable ablation of soft tissue in a short operation time with satisfactory results and excellent patient acceptance.

Detection of squamous cell carcinoma of the oral cavity by imaging 5-aminolevulinic acid-induced protoporphyrin IX fluorescence.

OBJECTIVES: Early cancer detection is the best way to improve the prognosis of patients with oral cancer. Therefore this study presents quantitative fluorescence measurements and results in the visualization of cancerous oral mucosa with 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PPIX). METHODS: Time progression and type of porphyrin accumulation were analyzed in neoplastic and surrounding healthy tissue of 58 patients with a suspected cancer of the oral cavity by measuring emission spectra of 5-ALA-induced PPIX fluorescence. Fluorescence images in the red and green spectral range from the tumor tissue were recorded with a charge-coupled device camera. RESULTS: After topical application of 0.4% 5-ALA and incubation for 1 to 2.5 hours, all patients revealed higher intensities of red fluorescence in neoplastic tissue compared with the surrounding normal tissue. Maximum contrast was reached after 1.5 hours of incubation. In 13.8% (n = 8) of the patients, additional findings like dysplasia, carcinoma in situ, primary tumor, secondary carcinomas, and tumor branches were found by means of fluorescence marking in contrast to white light examination. An evaluation of the biopsy specimens resulted in a specificity of 60% and a sensitivity of 99%. CONCLUSIONS: As a fluorescent marker, PPIX could represent a possible new diagnostic tool to detect early malignant and secondary lesions in the oral cavity. In addition, 5-ALA-induced PPIX fluorescence is promising as a useful intraoperative tool for determining adequate surgical margins of resection. Further investigations aim to assess this diagnostic procedure as a sensitive and clinically reliable method for patients with oral cancer.

Fluorescence staining of oral cancer using a topical application of 5-aminolevulinic acid: fluorescence microscopic studies.

INTRODUCTION: Topical application of 5-aminolevulinic acid (5-ALA) by means of a rinsing solution has been shown to be a promising new procedure in the diagnosis of oral malignancies. However, for assessing the reliability of this method regarding fluorescence-guided tumor resections and photodynamic therapy, further information on the distribution and penetration depth of 5-ALA-induced protoporphyrin IX (PPIX) in the tissue is needed. METHODS: 24 patients suffering from oral cancer were included in this investigation. Biopsies were taken immediately after fluorescence examination and either used as native sections for immediate fluorescence microscopic examination (n = 3) or shock frozen in liquid nitrogen and prepared as frozen sections (n = 46). Fluorescence imaging and digital image processing were utilized in order to determine the presence of PPIX in regions of various histologies as well as the penetration depth of PPIX into solid tumor. RESULTS: PPIX fluorescence in the tissue was limited to the epithelium. Both normal and dysplastic epithelium showed PPIX fluorescence. In the stroma, no PPIX fluorescence was found. In some cases (n = 3/4) invasive carcinomas did not show PPIX fluorescence, while the adjacent or overlying normal epithelium was strongly fluorescent. The penetration depth of PPIX after topical application of 5-ALA was found to be limited to less than 1 mm. CONCLUSION: PPIX fluorescence induced by topical application of 5-ALA can be very useful in the determination of superficial tumor margins. However, due to the limited penetration depth there is a risk of not accurately recognizing the infiltration depth of solid tumors. The aim of further investigations will be to assess the tissue distribution and depth of penetration of PPIX following systemic application of 5-ALA.

[3D-MRT-reconstructions of space-occupying lesions in the head and neck regions]. / 3D-KST-Rekonstruktionen bei Raumforderungen im Kopf-Hals-Bereich.

3-D reconstructions in the head and neck were carried out on 21 normals and 11 patients with space-occupying lesions, both before and after the administration of Gd-DTPA. The 3-D reconstructions were obtained by the "ray-tracing" method. For the 3-D reconstructions, portions of the skull surface image were removed to permit views of the deeper tissues. The 3-D reconstructions included an hypoglossus neurinoma, a glomus tumour, two carcinomas of the maxillary antra, three naso-pharyngeal carcinomas, a parotid adenoma, an oro-pharyngeal haemangioma and two lesions in the neck. The 3-D reconstructions provided a better understanding of the morphology than was obtained from the two-dimensional images. 3-D reconstructions of lesions in the head and neck will become a valuable diagnostic method for demonstrating space-occupying lesions, particularly with regard to surgical planning.

[MRT of tumors of the larynx and hypopharynx using Gd-DTPA: clinical value]. / KST von Tumoren des Larynx und Hypopharynx mit Gd-DTPA: Klinische Wertigkeit.

Thirty one patients with tumours of the larynx and hypo-pharynx were studied by MRI, both with and without the para-magnetic contrast medium, GD-DTPA. The results were compared with pre-operative laryngoscopy and the final pathological tumour classification. The most accurate results were obtained by comparing T1-weighted sequences before and after the use of GD-DTPA. Because of the relatively rapid mode of examination and the specific enhancement, the method proved ideal for evaluating tumours of the larynx and hypo-pharynx. MRI is a valuable diagnostic technique for staging and treatment planning of patient with tumours of the larynx and hypo-pharynx.

[Magnetic resonance tomography of the oropharynx and oral cavity with Gd-DTPA. An optimized study technic and its diagnostic value]. / Kernspintomographie des Oropharynx und des Cavum oris mit Gd-DTPA. Optimierte Untersuchungstechnik und diagnostische Wertigkeit.

In the evaluation of space-occupying lesions of the oropharynx it is necessary to perform modern imaging methods, such as magnetic resonance imaging additionally to clinical and endoscopical methods. 126 patients were examined using T1-weighted (TR = 500 ms, TE = 25 ms) and T2-weighted (TR = 3000 ms, TE = 25/90 ms) spin-echo-sequences before and after i.v. application of Gd-DTPA. Superficially growing lesions of stage T1 could not be delineated from isointense mucosa. The preoperative staging of T2-T4 lesions can be markedly improved by using T1- and T2-weighted sequences in combination with Gd-DTPA. MR imaging with Gd-DTPA is recommended as the primary diagnostic tool for diagnosing lesions in the region of the oropharynx.

[The clinical value of magnetic resonance tomography in cystic space-occupying lesions of the mouth floor]. / Klinische Wertigkeit der Magnetresonanztomographie bei zystischen Raumforderungen des Mundbodens.

11 patients with cystic lesions of the floor of the mouth were examined by MR imaging. Coronal slices provided an optimal visualisation of the lesions, but axial and sagittal slices added important information with regard to the exact topographic relationship between tumour and muscles. In particular, the mylohyoid muscle could be defined as a key structure. T1-weighted sequences enabled best visualisation of anatomic details, whereas T2-weighted sequences facilitated the primary diagnosis of cystic lesions. The contrast agent Gd-DTPA did not add information of significant diagnostic value. Our results indicate that MRI allows an exact visualisation of location and extent of cystic lesions and their relationship to surrounding muscles. We conclude that MRI is of high value in planning the operative strategy.

[MRI of the nasopharynx with Gd-DTPA: its value and differential diagnostic criteria]. / KST des Nasopharynx mit Gd-DTPA: Wertigkeit und differentialdiagnostische Kriterien.

81 patients with masses in the nasopharynx were examined by MRI and CT. In cases of primary lesions of the nasopharynx (such as carcinomas and fibromas), MRI with Gd-DTPA was superior to CT. Secondary tumors involving the nasopharynx were visualized equally well with MRI with Gd-DTPA and CT. The results show that MRI should be the primary method of examination in lesions of the nasopharynx. CT is a secondary procedure useful for showing small areas of bone erosion. MRI with the paramagnetic contrast medium Gd-DTPA permits differentiation between inflammatory, cystic and neoplastic masses.

[MR angiography for tumor diagnosis in the head-neck region: the study technic and clinical results]. / MR-Angiographie für die Tumordiagnostik in der Kopf-Hals-Region: Untersuchungstechnik und klinische Ergebnisse.

40 normal individuals and 153 patients with lesions in the head and neck were examined by conventional imaging methods and by means of MR angiography (1.5-tesla Magnetom). The problems to be solved concerned the relationship between tumors and vessels and vascular anomalies and abnormalities at the skull base (56 cases), the facial skeleton (62 cases) and the neck (35 cases). Digital subtraction angiography was performed in 54 patients and the findings correlated with MR angiography. Optimal results were obtained by using a FISP 3D sequence; in this way arterial structures could be rendered reproducibly down to a diameter of 2 mm. The venous system in the head and neck was best shown by a FLASH 2D sequence. Correlation with arterial DSA showed high accuracy of MR angiography (91%) concerning displacement of vessels, the topography and the recognition of vascular occlusions. Our results indicate that MR angiography is a rapid and reliable procedure for evaluating the arterial and venous changes due to tumors in the head and neck region.

[The facial nerve in the petrous bone in thin-layer paratransverse and sagittal magnetic-resonance-tomographic T1-spin-echo and FLASH images]. / Der Nervus facialis im Felsenbein in dünnschichtigen paratransversalen und sagittalen magnetresonanz-tomographischen T1-Spin-Echo- und FLASH-Aufnahmen.

PURPOSE: It is difficult to effect visualization and delineation of the facial nerve and its neighbouring structures in the temporal bone with conventional MRI examination protocols. We tested temporal bone MRI with 2 mm slices and compared T1-weighted FLASH (TR = 400 ms, TE = 10 ms, 90 degrees flip angle) and spin-echo (TR = 540 ms, TE = 15 ms) sequences. PATIENT AND METHODS: 5 volunteers and 14 patients were examined with the head coil of a 1.0T whole body MRI scanner (Impact, Siemens, Erlangen) with para-transversal images orientated parallel to the inferior outline of the clivus and sagittal images orientated along the brainstem. RESULTS: The facial nerve and its neighbouring structures could be reliably visualized and differentiated along its entire course. The FLASH sequence was superior to the spin-echo sequence. 8 of 11 patients with peripheral facial nerve palsy showed contrast enhancement. In two patients, local swelling of the affected facial nerve was evident. CONCLUSION: The MRI technique tested here seems promising for temporal bone examinations.

[Fat suppression in contrast-enhanced MRT of the base of the skull and of the head-neck area: its clinical value]. / Fettunterdrückung in der kontrastverstärkten MRT der Schädelbasis und der Kopf-Hals-Region: klinische Wertigkeit.

167 patients with abnormalities at the skull base and at the cervical-skull junction were examined by MRT in order to compare a FATSAT technique with T1- and T2-weighted SE sequences before and after intravenous injection of 0.1 mmol Gd-DTPA/kg KG. The diagnostic information from corresponding FATSAT and T1-SE sequences was correlated with the histopathological findings. In 10.7% of patients fat suppression was inadequate and in a further 11.3% of patients chemical shift artifacts limited the diagnostic value. The number of detectable lesions was not increased by the use of FATSAT sequences but visualisation of soft tissue lesions was improved, adding to the diagnostic value under specific conditions. Evaluating by the Friedman and Wilcoxon test showed that the postcontrast FATSAT sequences were markedly superior (p < 0.01) in delineating and contrasting the lesions. The additional use of contrast enhanced FATSAT sequences resulted in improved diagnosis of lesions at the skull base and the facial skeleton.

[The MRT of malignant tumors of the oral cavity and oropharynx with frequency-selective and inversion-recovery fat-signal suppression]. / MRT maligner Tumoren der Mundhöhle und des Oropharynx mit frequenzselektiver und Inversion-Recovery-Fettsignalunterdrückung.

PURPOSE: Evaluation of frequency-selective fat saturation (FS) and Short-Tau-Inversion-Recovery (STIR) fat suppression (FU) in MRI of patients with malignant tumours of the oral cavity or oropharynx. METHODS: Twenty patients with biopsy-proven squamous cell carcinoma of the oral cavity or oropharynx were examined by MRI at 1.0 T. A T2-weighted TSE-sequence with and without STIR-FU and a T1-weighted SE-sequence with and without FS were compared in axial slices. RESULTS: STIR-FU was successful in all and FS in 29/33 (87.9%) of the examinations. When visualisation and delineation of tumours were ranked on a four-point scale (0-3), respective mean values for images without/with FU or FS of 1.9 and 2.6 for T2-TSE, 1.4 and 1.3 for T1-SE without contrast media administration (CM) and 2.0 and 2.5 with CM were found. Signal/noise-ratios were inferior with FU and FS, but the tumour/muscle intensity ratio in CM-T1-SE improved with FS. CONCLUSIONS: STIR-T2-TSE and FS-T1-SE with CM were most useful for MRI of carcinomas of the oral cavity and oropharynx.

Intervascular smooth muscle fibers and muscular bolsters in nasal swell bodies of humans.

There is strong clinical evidence that the cavernous tissue (swell bodies) of nasal mucosa plays an important role in congestion of the nose. Still, the complex mechanisms responsible for the unique behavior of these vessels have not yet been identified, and even the morphology of these structures is still a matter of controversy. The present study was performed on nasal mucosal specimens from inferior turbinates of humans by means of histology and transmission electron microscopy. Besides the evaluation of the vascular wall structure of the nasal swell bodies, special attention was given to two morphological peculiarities: intervascular smooth muscle fibers and muscular bolsters. Intervascular smooth muscle fibers are composed of bundles of smooth muscle cells varying in diameter between 14 and 35 microns; they are attached to the muscular coat of the vessels of the cavernous tissue. Muscular bolsters are distinct protrusions of the vascular wall in nasal swell bodies; they are found not only at the transition between different vessels, but also irregularly within the course of veins of the cavernous tissue. The authors report on their understanding of the functional significance of intervascular smooth muscle fibers and muscular bolsters within the cavernous tissue for swelling mechanisms in the nose and discuss their results in light of the literature.

Vascular corrosion casts of the nasal mucosa. An experimental study in the rabbit.

Ten-rabbits of either sex, weighing between 1.8 and 2.7 kg were used for studies on the angioarchitecture of the nasal mucosa of the septum and the anterior concha. Via the common carotid artery, Batson's corrosion compound No. 17 was introduced into the vascular system of the nose after rinsing with Ringer's solution. After digesting the connective tissue between the vessels, vascular corrosion casts were obtained. The replica of the endonasal angioarchitecture offers a unique opportunity to examine the various vascular layers of the nasal mucosa as well as the junction and relationships between different vessels in the different levels of the tunica propria. Our results can be regarded as a useful extension of earlier investigations in this field.