[Multifocal adult rhabdomyoma of the neck: a rare entity]. / Wieloogniskowa postac rhabdomyoma adultum szyi.

Extracardiac rhabdomyoma comprise 2% of all tumors of skeletal muscle differentiation. Seventy percent of extracardiac rhabdomyoma occur in the head and neck region and have been subclassified into adult and fetal types. There are only about 100 cases reported in the literature. A review of the world literature revealed about 19 acceptable cases of benign, multifocal adult-type rhabdomyoma with a distinct male predominance. The pathogenesis of this benign striated muscle tumor is still unclear. These slow-growing tumors remain asymptomatic for a long period. The diagnosis of head and neck rhabdomyoma is based on histology and immunhistochemical studies. The differential diagnoses of rhabdomyoma in adults are myoblastoma or Abrikossof tumor, reticulohistiocytoma, rhabdomyosarcoma and hibernoma. We present a case of multifocal rhabdomyomas in the paratracheal and parapharyngeal space and discuss the clinicopathological features of this lesion. Although adult rhabdomyomas have a distinct histology, they often are mistaken for a variety of other lesions, particularly Abrikossof tumor. Light microscopy showed large round to elongated cells with granular, highly eosinophilic cytoplasm, often with peripheral vacuolation. Histology showed typical patterns of an adult type of rhabdomyoma with focal cross-striations. Immunhistochemically, all applied muscular markers were positive. Electron microscopic studies confirmed the tumor's myogenic origin. Myofibrils with Z band material, abundant mitochondria and glycogen particles were observed. Treatment is usually complete excision. Local recurrences have been reported in some cases; malignant degeneration is not known.

The importance of the voice in male-to-female transsexualism.

Transsexuality is a complex, permanent transposition involving a paradoxical feeling of belonging to the opposite sex. Furthermore, in the case of male-to-female transsexuals, the unchanged male voice, which is at odds with the female outward appearance, poses a serious obstacle to full social integration of the woman. One way of permanently raising the fundamental frequency, requiring little effort, is modified cricothyroidopexy via miniplates, which has been used in our hospital since 1993 following a technique developed by Isshiki (thyroplasty type IV). Until now, this operation has been performed on 67 female patients. To record the anatomical-morphological and functional data, preoperatively, post-operatively, and a year after the operation, a detailed voice diagnosis was made, laryngoscopy was carried out, X-rays were taken, and computer-assisted tomography was used to examine the larynx. Thus far, the functional results have been good. On average, the fundamental frequency has been raised by about one fourth. Whereas none of the female patients had a female-speaking voice before the operation, after the operation, about 30% of the patients' voices were in the female range, and 32% had at least a neutral-sounding voice.

Intralesional Cidofovir application in recurrent laryngeal papillomatosis.

Recurrent laryngeal papillomatosis is a benign disease of the larynx often leading to organic and functional restrictions. The therapeutic treatment of choice in larynx-obstructing papillomatosis is at present surgical laser ablation. The effectiveness of adjuvant intralesional injection of the virustaticum Cidofovir has been investigated recently in a variety of therapeutic models. The present case study deals with the treatment of recurrent laryngeal papillomatosis by means of surgical laser ablation of the laryngeal papillomas with adjuvant local injection of the virustaticum Cidofovir (dose of 5 mg/1 ml). Within the period from October 2001 to August 2004, ten patients aged between 5- and 70 years were treated with intralesional injections of Cidofovir. Papillomatosis was confirmed histologically in all cases, and the virus types were defined in part. Each of the patients underwent clinical-phoniatric examinations and was photographed for documentation. After 2-7 treatments with surgical laser papilloma ablation and intralesional Cidofovir injections, all patients showed a definite papilloma reduction, while in six cases complete remission was achieved. During the follow-up period of 8-30 months, not a single recurrence of the laryngeal papillomatosis occurred. In the majority of patients, a clear improvement in the voice was achieved. There were no local or systemic side effects caused by the virustaticum. Intralesional injection of Cidofovir is an adjuvant, but not a curative therapeutic option in recurrent laryngeal papillomatosis. Remission of previously frequently recurrent laryngeal papillomas can be achieved, but recurrence after longer treatment-free intervals is also possible.

Comorbid mental disorders in laryngectomees.

OBJECTIVES: This study attempted to determine the prevalence of mental disorders among laryngectomees and to assess the current status of the supplied psychooncological care. PATIENTS AND METHODS: Patients who were laryngectomized between 1970 and 2001 were recruited at 6 different otolaryngology clinics in the region of Central Germany. 189 interviews were conducted. Structured clinical interviews (SCID) and standardized questionnaires (HADS, KFA) were used to assess patients' mental health. The past and the current status of received psychotherapeutic care was evaluated. RESULTS: 23% of the patients were diagnosed with mental disorders. The most frequently occurring disorder was alcohol dependency with 8%, followed by affective disorders (7% major depression, 5% minor depression). Only one patient was currently receiving psychotherapeutic or psychiatric treatment. CONCLUSION: Only a small fraction of the laryngectomy patients suffering from mental illness were receiving appropriate treatment.