[Soft tissue tumors of the head and neck region]. / Weichteiltumoren des Kopf-Hals-Bereichs.

BACKGROUND: The incidence of soft tissue tumors of the head and neck region is low: 300 and 3 in 100,000 for benign and malignant tumors, respectively. However, sarcomas particularly show a wide variety of different histological subtypes. This article provides an overview of the soft tissue tumors of the head and neck region treated in the authors' institution. MATERIAL AND METHODS: This is a retrospective study including 106 patients treated between 2002 and 2010 due to a soft tissue tumor. Tumor- and patient-specific data were collected (benign/malignant tumor, location, TNM classification, therapy, R classification, grade). RESULTS: In total, 77 benign tumors, 5 of intermediate benign/malignant nature and 24 sarcomas (with 7 different subtypes) were identified. Whereas the benign and intermediate tumors were treated by surgical removal, in 21 of the 24 sarcomas, treatment comprised a multimodal therapy regimen including radio- and/or chemotherapy. CONCLUSION: Whereas benign tumors can be successfully treated by surgical resection, there is no uniform therapy regimen for sarcomas due to the variety of different histological subtypes. Only case-specific interdisciplinary disease management can offer good perspectives for therapeutic success.

Frequency of very late fatal sepsis after splenectomy for hereditary spherocytosis: impact of insufficient antibody response to pneumococcal infection.

Very late sepsis in splenectomized patients with hereditary spherocytosis has been seen rarely up to now; the frequency and the immunodeficiency causing it are largely unknown. Within the past 7 years we have learned of four cases of sepsis or meningitis (three fatal) in adult patients with hereditary spherocytosis who had been splenectomized years earlier. The estimated frequency of very late postsplenectomy infections is 0.69 cases of sepsis or meningitis in 1000 patient-years (0.46 deaths in 1000 patient-years). Pneumococci were proven in two patients. The surviving patient showed low antibody titers against pneumococcal serotypes even after pneumococcal meningitis and subsequent vaccination. There have been several reports of an insufficient response to pneumococcal vaccination in patients with severe infections. We recommend determination of pneumococcal antibody titers after immunization in every splenectomized patient: Nonresponders to vaccination may be at high risk for overwhelming postsplenectomy infection. Our data demonstrate that there is a lifelong risk for severe postsplenectomy infections and therefore the lasting need for immediate antibiotic therapy in any case with sudden onset of high fever.

Resection for CMV ileitis in a patient supported by a left-ventricular assist device.

We describe a patient requiring a HeartMate 1000 IP left-ventricular assist device (LVAD) due to cardiogenic shock. After prolonged gastrointestinal bleeding without identifying the source of bleeding technetium scintigraphy pointed to the right lower abdomen. The patient underwent a laparotomy and inflamed ileum was resected. Pathologic examination revealed cytomegalovirus ileitis. This was treated with ganciclovir and acyclovir. The patient is now (14 months later) awaiting heart transplantation since she could not be weaned from LVAD. The diagnostic and management problems are discussed as well as the relevance for future transplantation.

[Ambulatory co-disciplinary risk-adjusted preoperative care]. / Ambulante kodisziplinäre risikoadaptierte Operationsvorbereitung.

Routine preoperative studies in asymptomatic patients are not helpful for perioperative risk evaluation, and the cost is considerable. The decision regarding the status of a patient for elective surgery can be accurately predicted in 95% of cases on the basis of a complete history and physical examination alone; selective testing should be preferred. Interdisciplinary outpatient premedication is suitable for an individual risk evaluation, and a significant reduction in cost and inpatient treatment.

[Cause-oriented prevention of nosocomial pneumonia: the HI-LO EVAC tube]. / Kausalorientierte Prophylaxe der nosokomialen Pneumonie: der HI-LO EVAC Tubus.

Surgical high-risk patients were studied in a prospective randomized trial regarding nosocomial pneumonia (NP) using a subglottic lavage (SL). A total of 100 patients were investigated, in whom the primary infection was localized in the oropharynx. Independent of the kind of stress ulcer prophylaxis, intermittent subglottic lavage reduces the incidence of NP drastically to 3%, which is however, without statistical significance.

[Sore throat patients as the topic of a general practice quality circle. Determination and development of a practice guideline. Quality Assurance Study group for General Medicine]. / Halsschmerzpatienten als Thema eines hausärztlichen Qualitätszirkels.Bestandsaufnahme und Erarbeitung einer Handlungsleitlinie.

UNLABELLED: The present paper describes the institutionalization of a general practitioners' quality circle and the development of management guidelines for the treatment of patients with sore throat. Doctors participating: An invitation to attend an "information meeting" on the subject quality control and a quality circle sent to 200 general practitioners and internists, evoked a response by 18 physicians, ten of whom participated in the first meeting of the quality circle. Practical procedure: Stocktaking of the procedure in the doctor's office on the basis of a documentation questionnaire, the discussion of a video of the counselling of a patient with a sore throat, interviews with patients and the personal experience of the participating physicians was compared with a current analysis of the literature. The results of the comparison were taken as a basis for the development of management guidelines following the Dutch NHG Standard (Nederlands-Huisartsen-Genootschap-Standarden). RESULTS AND CONCLUSIONS: A wide variation was found in the treatment offered to patients with sore throats in the doctor's office. Deviation from text book information does not indicate a priori any quality deficit in the GP's practice. With respect to the management guideline worked out, it was agreed that in the individual case, a wellfounded deviation can be justified.

[Histochemical determination of vitality limits after the use of neodymium-YAG-lasers on parenchymatous organs]. / Histochemische Vitalitätsgrenzenbestimmung nach Einsatz des Neodym-YAG-Lasers bei parenchymatösen Organen.

Specific pediatric surgical problems, specially the hemisplenectomy and the partial liver resection in newborns and small children, offer a new indication for the laser beam. Special morphologic characteristics, like small organs and small vessels diameter, make the laser an useful procedure in children. With help of a histochemical technic could be shown a defined necrosis area - in dependence of the laser dose - in liver, spleen and kidney of rabbits under standard laser photocoagulation. Five days after the partial organ resection one could observe a well defined vital border, and after one week an invasive growing fibrotic tissue into the necrosis area, which would form the new capsula. No cases of infection or bleeding were present (84 partial organ resections). Using known doses one can exactly calculate the area of necrosis and evaporation.

[Doppler flow velocities in cerebral arteries in relation to intravenous phenobarbital in premature infants weighing between 500 and 1,500 g]. / Dopplerflussgeschwindigkeiten in zerebralen Arterien unter Phenobarbital i. v. bei Frühgeborenen zwischen 500 and 1,500 g.

In very premature ventilated infants (GA 25-30 weeks, BW 575-1420 g) values for heart frequency, mean arterial blood pressure and pCO2 were obtained, and also Doppler-sonographic measurements of the right internal carotid artery were performed to assess cerebral haemodynamics, before and 5-10 min after the intravenous injection of 20 mg/kg phenobarbitone (study I/n = 10) or 5 mg/kg phenobarbitone (study II/n = 10). There were no significant changes in any of these parameters. Therefore phenobarbitone does not have seem to have any significant effect on cerebral haemodynamics up to a dosage of 20 mg/kg, so that there is no apparent effect on the risk of cerebral haemorrhage. On the other hand this study confirms that phenobarbitone can be used in very low birth weight preterm infants with this dosage without causing any substantial haemodynamic risk.

Congenital cystic adenomatoid malformation of the lung associated with bile duct hypoplasia.

Congenital cystic adenomatoid malformation (CCAM) is a rare lesion that affects one or two lobes of the lung. Infants are either stillborn or die shortly after birth if therapy is not started immediately. The lesion itself may be solid or cystic, manifesting in an adenomatoid increase in terminal respiratory structures. Clinical, pathological and radiological findings of a child prematurely born are presented. A special feature in this case was hypoplasia of intrahepatic bile ducts, an unusual association with CCAM that has not been previously reported. Pathogenesis and embryological connotations of the two lesions are discussed. The importance of prenatal diagnosis and immediate surgical therapy after birth is stressed.

Alteration of surfactant function due to protein leakage: special interaction with fibrin monomer.

In isolated rabbit lungs standardized amounts of edema were induced. Stimulation with the Ca ionophore A23187, leukotriene C4, Pseudomonas aeruginosa cytotoxin and human serum (activated complement) all resulted in protein leakage into the alveolar space with no change in the total phospholipid content. The pressure-volume characteristics of the lungs and the characteristics of the lavage surfactant (Wilhelmy balance) were markedly altered, correlating to the lavage protein content. The surfactant alterations were reproduced by addition of perfusion fluid protein to control surfactant in vitro. All changes were far less expressed or even missing in isolated lungs developing the same amount of edema due to omittance of proteins from the perfusion liquid. Different proteins added to control surfactant in the Wilhelmy balance showed a marked rank order of potency in interfering with surfactant function: immunoglobulins G and M and elastin less than albumin less than fibrinogen less than fibrin monomers. The fibrin monomer effect was reproduced by addition of thrombin to a surfactant fibrinogen mixture and was partly reversed by subsequent incubation with plasmin. In conclusion, high-permeability edema induced by different means results in alterations of lung mechanics and surface activity of lavaged surfactant, presumably due to protein surfactant interaction. Among different proteins, fibrin monomers are especially effective in interfering with surfactant function.

Peroxidase-positive endothelial cells in sinusoids of the mouse liver.

The cytochemical localization of endogenous peroxidase activity in sinus lining cells of mouse liver has been investigated. Kupffer cells, as identified by their exclusive ability to phagocytize large (0.8 micron) latex particles, exhibited strong peroxidase activity in nuclear envelope and endoplasmic reticulum. In addition, weak to moderate peroxidase activity was found in 57% of all endothelial cells. The enzyme in endothelial cells was also localized in nuclear envelope and endoplasmic reticulum, with a negative reaction in the Golgi apparatus. These observations indicate that peroxidase staining, as a marker for identification of Kupffer cells in mouse liver, is only of limited value and should be used in conjunction with other methods (e.g., latex phagocytosis).