Lugol chromoendoscopy combined with brush cytology in patients at risk for esophageal squamous cell carcinoma.

BACKGROUND AND STUDY AIMS: Patients with achalasia or malignancies of the head and neck are at increased risk for esophageal squamous cell carcinoma. The discussion of a screening and surveillance program is controversial. The aim of the present study was to determine the diagnostic potential of Lugol chromoendoscopy combined with brush cytology to diagnose esophageal squamous cell carcinoma and high-grade dysplasia. Secondly, the benefit of additional biomarkers was investigated. PATIENTS AND METHODS: A total of 61 patients (21 patients with achalasia and 40 patients with malignancies of the head and neck) were included. Chromoendoscopy with 1.2% Lugol iodine solution with targeted biopsies and brush cytology processed by digital image cytometry (DICM) and fluorescence in situ hybridization (FISH) from unstained lesions (USLs) and stained mucosa were performed. RESULTS: Six of the 61 patients had USLs ≥2 cm. Four patients had high-grade dysplasia (HGD) or carcinoma in situ (CIS). One patient with HGD and one patient with CIS were detected only after Lugol chromoendoscopy. The sensitivity and specificity for detected HGD or CIS in USLs ≥2 cm were 100% and 96.5%. No dysplasia was found in USLs <2 cm. DNA ploidy by DNA cytometry and p53 loss of heterozygosity (LOH) by fluorescence in situ hybridization showed no additional impact on diagnostic accuracy. CONCLUSIONS: Lugol chromoendoscopy enhances the detection rate of high-risk lesions with dysplasia or carcinoma in situ in large unstained lesions. Biomarkers such as aneuploidy and p53 LOH from brush cytology were not of additional benefit in this setting.

[Blindness following reduction of a malar fracture]. / Erblindung nach Reposition einer Jochbeinfraktur.

Blindness is the most serious injury to the eye following a midfacial fracture. The onset of blindness complicating the midfacial fracture may be immediate (with the trauma), delayed (hours to days), or postoperative. The incidence of postoperative blindness lies between 0.3 and 8.3%. There are multiple mechanisms responsible for blindness but the most common reason with about 66% is probably increased intraorbital pressure attributable to intraorbital hemorrhage. The management of surgical decompression of the orbit for acute blindness is essential when treatment of a midfacial fracture is intended. Acute orbital compartment syndrome can effectively be relieved by lateral canthotomy and cantholysis and administration of high doses of corticosteroids. Further possibilities of surgical decompression of the orbit are discussed in this case report with postoperative irreversible blindness after reduction of a malar fracture and rapidly performed surgical decompression.

Proteasome inhibitor induced gene expression profiles reveal overexpression of transcriptional regulators ATF3, GADD153 and MAD1.

The ubiquitin/proteasome pathway has been implicated in a wide variety of cellular processes and the number of substrates degraded by the proteasome is impressive. Most prominently, the stability of a large number of transcription factors is regulated by ubiquitination. To elucidate pathways regulated by the proteasome, gene expression profiles were generated, comparing changes of mRNA expression of 7900 genes from the UniGene collection upon exposure of cells to the proteasome inhibitors Lactacystin, Lactacystin-beta-lactone or MG132 by means of microarray based cDNA hybridization. The three profiles were very similar, but differed significantly from a gene expression profile generated with the histone deacetylase inhibitor Trapoxin A, indicating that the observed alterations were indeed due to proteasome inhibition. Two of the most prominently induced genes encoded the growth arrest and DNA damage inducible protein Gadd153 and the activating transcription factor ATF3, both transcription factors of the CCAAT/enhancer binding protein (C/EBP) family. A third gene encoded for the transcriptional repressor and c-Myc antagonist Mad1. Our results suggest that proteasome inhibition leads to upregulation of specific members of transcription factor families controlling cellular stress response and proliferation. Oncogene (2000).

Effects of tracheostomy on human tracheobronchial mucosa: a scanning electron microscopic study.

The protective functions missing in the upper airways of tracheostomy patients lead to functional and morphological changes in the lower respiratory tract. To obtain detailed data from the surface of the tracheobronchial mucosa, a scanning electron microscopic study was performed. Mucosal biopsies were taken from different sites of the tracheobronchial tree in 5 healthy control subjects, 5 patients with tracheostomy after laryngectomy, and 5 tracheostomy patients not affected by a history of smoking. Following scanning electron microscopic examination, the specimens were evaluated morphometrically. The percentage ciliary border and the individual mucosal surface changes depended on the biopsy site and the degree of previous damage. Individual structural alterations consisted of squamous metaplasia, giant cilia, compound cilia, and microplicae. Giant cilia represented an impressive form of differentiation in chronic bronchitis recognizable by scanning electron microscopy.

Correlative histological and ultrastructural study of unusual changes in human tracheobronchial epithelium.

In tracheostomy patients with chronic bronchitis, scanning electron microscopy reveals detailed surface changes in the tracheobronchial mucosa. The principle of intermicroscopic correlation, i.e., the sequential examination of a specimen by different microscopic procedures, is illustrated with giant cilia. After re-embedding the scanning electron microscopic specimens and precisely locating a ciliary convolution by light microscopy in semithin section, the giant cilia were studied in ultrathin sections by transmission electron microscopy. The cilia were shown to be at least 9 microns long (normal ciliary length = 4-6 microns). Central and peripheral microtubular axonemal structures with a 9 + 2 arrangement were clearly shown in both longitudinal and cross section. Giant cilia, thus, most closely resemble outgrowths of normal cilia. If they are motile at all, they seem unlikely to effect a transport function coordinated in direction and time.

Carbon dioxide laser surgery in otorhinolaryngology: pulsed beam versus continuous wave beam.

According to various authors, the use of the carbon dioxide laser beam in pulsed form has the following advantages: better cutting action at the same mean power as that of the continuous laser, and less tissue damage at the edge of the cut. To date, however, there are no conclusive tests that demonstrate that pulsed operation of the CO2 laser has clear advantages over continuous operation. This study compares the effects of a pulsed laser and a continuous laser on freshly removed human palatine tonsils and skeletal muscle tissue. The depth of thermal tissue damage was measured microscopically. It was observed that the depth of damage at the edge of the cut tissue decreased with increasing power density with both the pulsed laser and the continuous laser. With comparable power densities, however, pulsed operation unexpectedly produced somewhat deeper damage at the edge of the cut than did the continuous operation. The results obtained indicate that the pulsed CO2 lasers available today have no advantages over the continuous mode CO2 lasers for otolaryngologic surgical applications.

Cholesterol granuloma of the paranasal sinuses.

Cholesterol granulomata of the middle ear occasionally accompany chronic middle-ear diseases with diminished ventilation. In the paranasal sinuses, especially in the frontal sinus, they have occasionally been mentioned in the literature. Disordered ventilation and impaired drainage are decisive pathogenic factors in the causation of cholesterol granuloma. Views remain divided on the source of the cholesterol and on the importance of bleeding in the development of cholesterol granuloma. Two patients with a cholesterol granuloma of the frontal sinus are presented and discussed.

Resection of palatal tumours with the CO2 laser.

On the basis of the authors' experience with 20 patients, CO2 laser resection of palatal tumours has proved to be a good alternative to conventional surgical resection. The CO2 laser beam permits precise resection, due to only slight intra-operative bleeding coupled with use of the operating microscope. Wound healing is good and post-operative pain remarkably little.

[Botulinum toxin A as a treatment of traumatic salivary gland fistulas]. / Botulinumtoxin A zur Therapie traumatischer Speichelfisteln.

Injury of salivary gland tissue in the head and neck, as the result of extensive trauma, can often be overlooked on initial examination. In two case reports, the primary treatment and further follow-up of injuries of the head resulting in a parotid-maxillary sinus fistula as well as a fistula between the skin and sublingual gland are illustrated. The successful use of botulinum toxin in the treatment of traumatic salivary gland fistulas is documented in both cases. Alternative diagnostic and treatment measures of salivary gland fistulas are discussed. Surgical repair of salivary fistulas as primary treatment should be carefully considered. Treatment of a salivary fistula with the injection of botulinum toxin is possibly advantageous compared to spontaneous fistula closure. The injection of botulinum toxin shortens fistula closure time, is minimally invasive, effective and tolerable for the patient.

[Round window membrane pathology in sudden deafness (author's transl)]. / Pathologie des runden Fensters bei akuter Ertaubung

Exploration of the middle ear was performed on 15 patients with sudden deafness that had failed to improve after intravenous infusion of Eupaverin and Rheomacrodex. Three patients had abnormalities of the round window membrane, in 2 there was a perilymphatic fistula and in 1 an abnormal bulging of the membrane with no transmission of perilymphatic fluid movement. These 3 patients presented with a history of exertion or stress prior to the onset of symptoms. Surgical closure ofthe 2 fistulae led to improvement of hearing, and perilymphatic decompression in the third patient improved the tinnitus but not the deafness. The possible causes of round window pathology are discussed.

Laser surgery in the oral cavity.

As a cutting instrument, the CO 2 laser is the most suitable type of laser currently available for medical applications. It has proved particularly advantageous in surgery of the upper aerodigestive tract, as its energy-absorbing properties, which do not depend on dyes, allow its effect in tissue to be controlled accurately. Additionally, the slight degree of postoperative edema is invaluable, especially in the region of the upper respiratory passages.

[Significance of the CEA-Test in malignomas of the head and neck (author's transl)]. / Stellenwert des CEA-Testes bei Malignomen im ORL-Bereich.

Serum carcinoembryonic antigen (CEA) levels were determined in 80 patients, 65 with malignant and 15 with non-malignant affections. Among the malignant tumor bearing patients, in only 30% increased CEA levels were found. On the other hand, in the non-malignant patient group 33% had elevated CEA levels. It is concluded, that the determination of the CEA-Serum levels in malignomas of the head and neck has no diagnostic significance.

[Initial experiences with endolaryngeal CO2-laser surgery in circumscribed laryngeal cancer]. / Erste Erfahrungen mit der endolaryngealen CO2-Laser-Chirurgie beim umschriebenen Kehlkopfkarzinom.

Minimal intraoperative bleeding, the advantage of precise cutting under microscopic control, and the near total absence of postoperative edema make the CO2-laser particularly suited for endolaryngeal surgery. Between October 1978 and July 1982, 22 patients with early carcinoma of the larynx (8 carcinoma in situ, 2 verrucous carcinoma, 12 T1 true vocal cord carcinoma) have undergone endolaryngeal resection with the CO2-laser at the ENT-Department of the University Hospital of Zurich. All patients were hospitalized for three to four days. None of them needed a tracheostomy. Follow-up ranges from three month to four years (average 17 months). So far there have been no recurrences. The quality of the postoperative voice varies from poor to fairly good, depending on the extent of the resection and on the amount of scarring. Compared to conventional chordectomy via laryngofissure, which necessitates tracheostomy, endolaryngeal laser-chordectomie is tolerated better and more cost-effective. Recurrences after endolaryngeal laser-chordectomy are still amenable to voice-saving radiation therapy.

[Surgical therapy of severe carotid sinus syndrome]. / Zur chirurgischen Therapie bei schwerem Karotissinussyndrom.

A 76 year old female, suffering from a severe carotid sinus syndrome, is presented. Conventional therapeutic measures with medication, radiation and implantation of a pacemaker did not influence her syncopal attacks. She sustained several syncopes daily and was forced to almost permanent bedrest. Only with an operative procedure, consisting of bilateral microsurgical carotid sinus denervation, the patient could finally be relieved from her syncopal attacks.

[The CO2 laser in oto-rhino-laryngologic surgery]. / Der CO2-Laser in der Hals-Nasen-Ohren-Chirurgie.

Experience with 122 CO2-laser procedures is reported. 68 operations were performed in the larynx, 13 in the pharynx, and 10 in the oral cavity. 30 were tonsillectomies and 1 excision of a exophytic skin tumor. The advantages of CO2-laser surgery are minimal hemorrhage during surgery, excellent visibility in the operative field, only slight postoperative edema and reduced pain in the postoperative period. Surgery with the CO2-laser beam is beneficial for the following indications: endolaryngeal microsurgery, procedures in highly vascularized organs (tongue) or on well vascularized tumors (hemangioma), and surgery in hemophiliacs.