Validity of sentinel node biopsy in early oral and oropharyngeal carcinoma.

PURPOSE: This study investigates the possibility and sensibility of using sentinel node biopsy (SNB) during surgery for oropharyngeal carcinomas with clinically and radiographically unremarkable cervical lymph nodes. MATERIALS AND METHODS: A total of 36 patients who were treated for early oral and oropharyngeal carcinoma and unremarkable cervical lymph nodes were included in this study. After lymphoscintigraphy for detecting sentinel lymph nodes (SLN), the SLN were excised first. Thereafter elective neck dissection was performed. Histopathological and immunochemical examinations were used to examine the SLN and all other lymph nodes. RESULTS: The preoperative SLN detection rate was 97.2% (35 of 36). SLN in level V were detected in four patients (11.1%). Metastases were found in 33.3% of the patients (12 of 36). All metastases were in the marked SLN. No skip metastases could be detected. A specificity of 100% and a sensitivity of 94.4% were identified for the SNB. CONCLUSION: The study confirms that SNB is a precise diagnostic procedure for assessing the nodal status of cervical lymph nodes. Further studies are needed to determine whether SNB without elective neck dissection for clinically and radiologically unremarkable cervical lymph nodes can become a reliable course of treatment for carcinomas of the head and neck region.

[Value of color-coded Doppler sonography in the differential diagnosis of nodular thyroid gland changes]. / Stellenwert der farbcodierten Doppler-Sonographie in der Differentialdiagnostik nodulärer Schilddrüsenveränderungen.

AIM: The incidence of functional autonomous adenomas, detected in every second nodular goiter by scintigraphic methods is very high in an area of iodine deficiency. The color-coded Doppler sonography (CCDS) as a diagnostic tool in differentiating thyroid nodules is discussed controversially. METHODS: In this prospective study we investigated the value of CCDS in 200 patients with nodular thyroid alterations compared with 99m-Technetium (Tc) scintigraphy. RESULTS: Focal maximas of Tc-uptake were detected in 22.5% of all patients, and 44.5% of the thyroid nodules showed increased vascularity. There was no correlation between nodular vascularity and thyroid 99m-Tc uptake (TcTU). In contrast to this we could demonstrate a significant relation between vascularity and the diameter of the nodule (p < 0.0001). The results are discussed in the context of method specific limitations of ultrasound examinations. CONCLUSION: Our results confirm that CCDS has no great importance in the differentiation of thyroid nodules. Scintigraphy remains the diagnostic method of choice to assess the topographic thyroid function.

[Combination therapy of endemic goiter with two different thyroxine/iodine combinations]. / Studie zur Kombinationstherapie der endemischen Struma mit zwei unterschiedlichen Thyroxin/Iodkombinationen.

AIM: Of this study was to investigate the extent of thyrotropin (TSH) suppression and volume reduction in combination therapy of endemic goitre. We compared an individually adapted dose of thyroxine with a fixed dose. METHODS: 105 patients of a multicenter study (randomised, single blinded, controlled) received daily a weight-adjusted LT4-dose in combination with 150 micrograms iodide (group A) or a fixed combination of 100 micrograms LT4 plus 100 micrograms iodide (group B), respectively. At the beginning and after 12 weeks TSH-levels and goitre volume were examined. RESULTS: Although the amount of thyrotropin suppression showed no differences in both groups, there were more patients in the weight-adjusted treatment group with completely suppressed thyrotropin serum concentrations (p < 0.05). Both groups showed a reduction of goitre volume of 24% CONCLUSION: A weight-adjusted LT4-dose of 1.4 micrograms/kg body weight often leads to subclinical hyperthyroidism. To obtain low TSH-levels without complete suppression LT4-doses of 1.0 microgram/kg body weight plus 150 micrograms iodide are probably sufficient.

The influence of differences in hydration on bone-to-soft tissue ratios and image quality in bone scintigraphy.

This prospective study evaluated the effects of different amounts of fluid intake on the bone-to-soft tissue (B:ST) ratio and image quality of bone scans performed using Tc-99m MDP. One hundred sixty patients with no renal disease were divided into three groups with different degrees of hydration in liters (group 1, 0.25 I; group 2, 1 I; group 3, 1.5 I), and image quality was assessed with a semiquantitative score. The B:ST ratio was calculated over the femoral diaphysis and adductor area, respectively. No significant differences in the B:ST ratio or image quality were demonstrated in all three patient groups with median values of 1.90 (group 1), 1.93 (group 2), and 1.84 (group 3). A filled urinary bladder was associated with greater fluid intake. The B:ST and image quality were correlated directly with the postinjection time interval and inversely with age. When patients drink a large volume of fluid, B:ST ratios do not necessarily increase and bone scintigraphy image quality does not improve.

[Resource diagnosis with children]. / Ressourcendiagnostik bei Kindern.

Traditionally the task of diagnosis in psychotherapy with children is the description of the disturbed behavior and the analysis of its causes. But the deficit-oriented perspective leads as a rule to a neglection of the clients', positive potentials, whose inquiry and therapeutic use for the success of therapy is however, following new findings of therapeutic effect research, of eminent significance. By this article a concept of resource diagnosis is introduced that demonstrates by several examples from the practice different methods of resource analysis with children based on a resource taxonomy. Finally a detailed case presentation illustrates the enlarged possibilities which are offered by the combined application of deficit and resource analytic results for therapy planning and intervention.

[Plan diagnosis with children]. / Kinderplandiagnostik.

Plan Analysis, a method introduced by CASPAR (1989, 1996) to develop individual case conceptualizations for adult therapy, is an important diagnostical approach for the planning of child therapies, as well. Compared with the procedure for adults, the inferring of child plans requires partially modified strategies which are presented, discussed, and demonstrated by a concrete example of case conceptualization. Plananalytic developed case conceptualizations allow the derivation of general therapeutic change goals and modification strategies which are finally presented.

Obtaining medical information from the Internet.

The Internet is rapidly expanding as an environment for electronic communication and resource sharing. The World Wide Web, a relatively new service on the Internet, provides access to a wealth of information resources through a simple point-and-click interface. Available resources of interest to physicians include bibliographical and statistical databases, literature reviews, discussion groups, press releases, newsletters, drug information, self-assessment questionnaires, multimedia textbooks, patient simulations, clinical decision aids, educational software, and much more. Access to the Internet is widely available in universities and medical libraries; physicians working at home can gain access from a personal computer linked by a modem to a telephone line, by subscribing to an Internet service provider.

Clinical problem solving by computer.

Computer access to the medical literature has become more convenient than ever with MEDLINE and other bibliographical databases available on CD-ROM. The benefits of literature searching by computer include improvements in the quality of medical decision making and cost effectiveness of patient care. However, the results obtained by physicians with amateur searching skills are often inferior to those obtained through the traditional service mediated by a skilled librarian. To ensure that future physicians develop the skills necessary for effective use of the medical literature, it is essential to provide training in literature searching by computer at medical school.