Value of apparent diffusion coefficient calculation before and after gustatory stimulation in the diagnosis of acute or chronic parotitis.

The purpose of the study was to investigate the value of diffusion-weighted (DW) echo-planar imaging (EPI) for quantifying physiological changes of the parotid gland before and after gustatory stimulation in patients suffering from acute or chronic recurrent inflammation in comparison with healthy volunteers. Using a DW-EPI sequence at 1.5 T, parotid glands of 19 consecutive patients with acute (n=14) and chronic (n=5) inflammation of parotid glands and 52 healthy volunteers were examined. Magnetic-resonance (MR) images were obtained before and after gustatory stimulation with 5 cc of lemon juice. In volunteers mean ADC values of 1.14 x 10(-3) mm(2)/s before and 1.2 x 10(-3) mm(2)/s after gustatory stimulation were observed. In acute inflammation ADC values were higher before [1.22 x 10(-3) mm(2)/s (p=0.006)] and after stimulation [1.32 x 10(-3) mm(2)/s (p<0.001)]. Before stimulation ADC differences between chronic inflammation (1.05 x 10(-3) mm(2)/s) and healthy volunteers (p=0.04) as well as between acute and chronic inflammation (p=0.005) were statistically significant. No differences were detected after stimulation between chronic inflammation (1.2 x 10(-3) mm(2)/s) and healthy volunteers (p=0.94) and between acute and chronic inflammation (p=0.15), respectively. DW-EPI seems to display the physiological changes of the parotid gland in patients suffering from acute or chronic inflammation and might be useful for discriminating healthy from affected glands.

[The value of hyperbaric oxygen therapy (HBO) in treatment of problem wounds in the area of plastic-reconstructive head and neck surgery]. / Der Stellenwert der hyperbaren Sauerstofftherapie (HBO) in der Behandlung von Problemwunden im Bereich der plastisch-rekonstruktiven Kopf-Hals-Chirurgie.

BACKGROUND: Hyperbaric oxygenation therapy is presently predominantly discussed in connection with sudden deafness and tinnitus. Amongst this ongoing controversy, the primary indications of this in the middle of the 20th century established therapy, especially in regard to problem wounds in the plastic-reconstructive surgery go mainly underrated. The present paper reviews the attention towards this area in plastic surgery. PATIENTS AND METHODS: Three typical cases (traumatic nasal tip reconstruction, wound ulceration after radiotherapy and lobe necrosis together with fistula following laryngopharyngectomy) are presented. RESULTS: Because of protracted and complicated wound healing HBO was applied in all three cases, eventually leading to very satisfying subconsequent wound-healing. In connection with these cases, the underlying problems and the effects of HBO are discussed. SUMMARIZING: The authors conclude, that HBO primary clinical application in treatment of problematic wound healing in head and neck appears to be very effective and helpful and should not be underrated whilst discussing this therapy in different contexts.

[Tumor oxygenation in combined whole body hyperthermia and polychemotherapy. Studies exemplified by recurrent carcinoma of the mouth cavity]. / Tumoroxygenierung unter kombinierter Ganzkörperhyperthermie und Polychemotherapie. Untersuchungen am Beispiel eines Rezidivkarzinoms der Mundhöhle.

BACKGROUND AND OBJECTIVE: Previous studies have reported synergistic effects of combined hyperthermia and chemotherapy and/or irradiation. The response to irradiation and chemotherapy of well-oxygenated and vascularized tumors generally is better than that of hypoxic tumors. Therefore, tumor oxygenation is recognized as an important predictive factor in the therapy of malignant tumors. In practice, the head and neck area remains outside of the hyperthermia chamber during whole-body hyperthermia. It was the aim of this study to evaluate if the head and neck region receives sufficient warmth and, if so, if tumor oxygenation increases accordingly. PATIENTS/METHODS: Whole-body hyperthermia, as heat radiation (Enthermics Medical Systems RHS-7500), was applied to the narcotised 60-year-old male patient with a local recurrence tumor pT3 pN2b M0 squamous cell carcinoma of the oral cavity. Tumor oxygenation and temperature were measured by LICOX catheters via one-point measurement during the entire hyperthermia treatment (3.5 h). Parallelly, chemotherapy (ifosfamide/Carboplatin) was given in four cycles (one cycle/month). RESULTS: With a latency of 10 min the increase of intratumoral temperature was comparable to temperatures achieved in the esophagus. The maximum intratumoral temperature was 41.8 degrees C. The average increase in tumor oxygenation was more than 100%. The clinical outcome in the case presented was a partial tumor remission (PR). CONCLUSIONS: During combined whole-body hyperthermia and polychemotherapy, tumor oxygenation is also significantly improved in the head and neck area, despite the fact that the head and neck area remained outside the hyperthermia chamber. The intratumoral temperature was comparable to esophageal and rectal temperatures.