Neuroendocrine differentiation in head and neck squamous cell carcinoma.

OBJECTIVE: Tumours with neuroendocrine differentiation frequently express chromogranin A, synaptophysin and somatostatin receptors. The role of neuroendocrine differentiation in head and neck squamous cell carcinoma is not yet clear. METHOD: The presence of chromogranin A, synaptophysin and somatostatin receptors was studied immunohistochemically in 78 head and neck squamous cell carcinoma specimens. RESULTS: Sparse chromogranin A expression was found in 41 per cent, associated with high chromogranin A messenger RNA expression and the presence of dense core granules. Low synaptophysin expression was found in 18 per cent. The highest staining scores were found for somatostatin receptor 5 (82 per cent), followed by somatostatin receptor 1 (69 per cent) and somatostatin receptor 2 (54 per cent), whereas somatostatin receptors 3 and 4 expression was low. Expression was not correlated with tumour stage or survival. CONCLUSION: Cells with neuroendocrine differentiation are sparsely scattered in some head and neck squamous cell carcinomas. Their pathophysiological role is elusive. In contrast, somatostatin receptor and particularly somatostatin receptor 5 expression is frequent in head and neck squamous cell carcinoma. Somatostatin receptor expression is not considered to indicate neuroendocrine differentiation in head and neck squamous cell carcinoma.

Complications related to midfacial fractures: operative versus non-surgical treatment.

The treatment of midfacial fractures depends on the dislocation of the fracture and patient-related limitations. Surgical treatment risks iatrogenic complications. In 740 patients with midfacial fractures, the age, sex, fracture type, concomitant injuries, cause of accident and the decision to use operative or non-surgical treatment were recorded. Follow-up was performed 6 and 12 months after the injury. In 41% the fractures were isolated; they were multiple in 59%. Initially, hypaesthesia of the infraorbital nerve was present in 10% of the single and 16% of the multiple fracture patients. Surgical treatment was performed in 57% of the single and in 75% of the multiple fracture patients. Women underwent surgical treatment considerably less frequently than men. After 6 and 12 months, significantly more complications were present in the surgically treated cohort. Nerve disturbances and 'meteorosensitivity' were most prominent. These results, together with previous findings, indicate that there is a need for prospective clinical investigations that fulfil the criteria of evidence-based medicine to generate guidelines for decision making in trauma surgery. In the meantime, the decision to use surgical treatment for midfacial fractures has to be made carefully.

High resolution ultrasound investigation of the temporomandibular joint in patients with chronic polyarthritis.

40 patients with chronic polyarthritis were investigated prospectively. The TMJ was investigated to detect clicking, crepitation, and pain. High resolution ultrasound (HR-US) assessed destructive changes, effusion, and disc dislocation. The results of the clinical investigation and the HR-US investigation were compared using the χ(2) test. The statistical calculation of the correlation between the HR-US results and the clinical TMJ investigation by the χ(2) test showed a significant correlation between TMJ sounds, destructive changes and disc dislocation. A significant correlation between TMJ joint effusion, TMJ pathology and TMJ pain was detected using the χ(2) test. Pain on palpation of the masseter and temporal muscle correlated significantly with TMJ effusion. There was significant correlation between TMD and the HR-US diagnosis of destructive changes and effusion. The significant correlation between TMJ effusion and actual TMJ pain and TMJ pain on palpation shows the ability of HR-US to detect acute TMJ affection with high significance. There was a significant correlation between effusion and pain on palpation of the masticatory muscles, which could be interpreted as the ability of HR-US to determine acute TMD. That any TMD correlated significantly with destructive changes and TMJ effusion suggests that HR-US could detect chronic and acute TMD.

Ep-CAM expression in pancreatic and ampullary carcinomas: frequency and prognostic relevance.

AIMS: Pancreatic adenocarcinoma is an aggressive gastrointestinal malignancy with only a few long-term survivors even after radical surgery. Patients with ampullary cancer have a better prognosis but adjuvant therapy needs further improvement. Epithelial cell adhesion molecule (Ep-CAM) is strongly expressed in a variety of epithelial cancers and represents a promising target for immunological tumour therapy. Thus, the aim of this study was to investigate Ep-CAM expression and its potential prognostic impact in pancreatic and ampullary carcinomas. METHODS: Ep-CAM expression was investigated retrospectively by immunohistochemistry in paraffin-embedded primary tumour tissue samples from a series of consecutive patients with pancreatic (n = 153) and ampullary cancer (n = 34). RESULTS: Ep-CAM overexpression was observed in 85 of 153 pancreatic cancer specimens (56%) and in 29 of 34 ampullary cancer samples (85%). Overall, Ep-CAM failed to be an independent prognostic marker. However, subgroup analyses showed that Ep-CAM overexpression correlated with shorter overall survival among patients with ampullary cancer and advanced stage pancreatic cancer. In the latter subgroup, survival gradually worsened with increasing Ep-CAM scores. Furthermore, in ampullary cancer, Ep-CAM overexpression was found to correlate with tumour stage. CONCLUSIONS: Ep-CAM overexpression was detectable in the majority of cases with pancreatic and ampullary cancer. Therefore, Ep-CAM represents an attractive target for immune-based therapeutic interventions in these tumour entities. However, the prognostic value of Ep-CAM overexpression remains undetermined.

The impact of ageing on cranio-maxillofacial trauma-a comparative investigation.

The number of patients older than 65 is increasing in developed societies. The impact of age on injuries and their outcome has been well documented in several fields of traumatology. Data on a broad cohort suffering from oral and maxillofacial injuries are missing. In this study, the data of 12,572 such patients were collected, of which 11,798 were younger and 774 were older than 65 years. With increasing age the risk of a domestic accident increased. The accident mechanism in elderly people was most frequently a fall (72%) or was not reproducible (12%). There was a significant difference between groups regarding concomitant injuries. Additional neurological symptoms occurred in 26% of the older and 15% of the younger patients (P<0.001). Until the age of 65 the risk of concomitant neurological injury increases. Injuries in the older patients mainly affected the soft tissue and midface. No statistical differences in surgical postoperative complications were observed. Due to the changing face of society, the treatment of elderly people is of high relevance. To enable an independent life after trauma, pre- and post-therapeutic care is of major importance. These data support surgical treatment of all patients, regardless of age, driven by general health condition whenever possible.

[Temporomandibular disorders in juvenile patients with rheumatic diseases]. / Kiefergelenkbeschwerden bei juvenilen Patienten mit rheumatischen Erkrankungen.

PURPOSE: The aim of the study was to investigate the incidence of temporomandibular disorders (TMD) in juvenile patients with rheumatic diseases. Furthermore, correlations between the degree of the rheumatic disease and the clinical symptoms were evaluated. MATERIAL AND METHODS: In a prospective investigation the temporomandibular joints of 48 children with rheumatic diseases were evaluated clinically regarding clicking, crepitation, pain, duration of the rheumatic disease, and the number of affected peripheral joints. The degree of rheumatic disease was assessed with Steinbrocker's classification. RESULTS: 26 patients (54.17%) showed clinical symptoms of TMD. No significant correlation was found between the degree of the rheumatic disease and the awareness of TMD. A high number of affected peripheral joints does not lead to a significant increase of TMD. A significant correlation between the duration of the rheumatic disease and TMD could be detected. A significant correlation between the duration of the rheumatic disease and clicking or crepitation was found ( p=0.011). CONCLUSION: Rheumatic diseases lead to a higher incidence of TMD in juvenile patients. A longer duration of rheumatic diseases leads to a higher incidence of TMD.

[Acute increased intracranial pressure--first symptom of renovascular hypertension? (author's transl)]. / Akuter Hirndruck--Erstmanifestation der renovaskulären Hypertonie im Säuglingsalter

The authors report the history of a 7 months old male infant who showed acutely increased intracranial pressure associated with hydrocephalus internus. These symptoms appeared probably as the first manifestation of severe renovascular hypertension. The possible etiologic relations are discussed.