[Head and Neck Cancer in Pregnancy - Recommendations for Diagnosis and Therapy With Case Report]. / Kopf-Hals-Krebs in der Schwangerschaft ­ Empfehlungen zu Diagnostik und Therapie mit Fallbericht.

Objective: The diagnosis of cancer in pregnancy is rare, but might become more relevant even for head and neck cancer patients due to a shift of age of primipara towards the last third of reproductive years. Unsureness exists about the risk and benefit of diagnostic and therapeutic cancer modalities for the unborn and established recommendations are still missing. But, according to recent data, even multimodal therapeutic approaches (e. g. surgery, radiation, chemotherapy) seem possible in face of pregnancy and should be traded against the risk of prematurity. Material and Methods: Our findings are discussed on the basis of a case report of a pregnant woman with advanced carcinoma of the outer ear canal and therapy options are formulated. Results: Sufficient performed diagnostic modalities do not reach imperilling uterus dosages. A growing number of case reports und studies did not detect any developmental disadvantage of children of prenatal exposed mothers by radiation or chemotherapy, whereas long-term impairments of premature infants are proven. Conclusion: In cancer in pregnancy, an immediate start of well-established therapy modalities like surgery and/or cisplatin-based chemoradiation seems to be possible without unjustifiable risks for the unborn.

[Gene expression analyses and their possible clinical benefit in head and neck cancer]. / Genexpressionsanalysen und ihrmöglicher klinischer Nutzen inder Betrachtung der Kopf-Hals-Karzinome

Systems biology approaches for mutational (exome analysis and targeted sequencing) and gene expression analysis (transcriptome-wide gene expression profiling) represent a new and growing scientific field in head and neck oncology. In addition to medical biological expertise, bioinformatic assistance is increasingly required. For squamous cell head and neck cancer (HNSCC), the recent molecular genetic single-gene and signal pathway observations represent basic research. Important aspects of this have now been significantly enhanced by systems biology approaches, which have grown into relevant areas of translational clinical research. It is now known that HPV16 is associated with genetic alterations at various locations, but also that it functionally affects genes not altered in their base sequence at the level of methylation. In transcriptome analyses, various consortia found matching clusters of gene expression and HPV16 association with the spectrum of somatic mutations. The differential methylation of gene promoters discovered in HPV16-driven HNSCC proved predictive for survival­even in HNSCC patients without HPV detection. The authors present an overview of some translationally relevant findings and venture an outlook on possible future clinical developments.

[Gelatin-thrombin matrix-mediated hemostasis: application in tonsillectomy]. / Gelatine-Thrombin-Matrix zur Blutstillung: Einsatz bei der Tonsillektomie.

BACKGROUND: To assess the feasibility of omitting thermal coagulation following cold knife tonsillectomy, we compared the use of a local thrombin hemostat (FloSeal®, FS) to bipolar electrocautery (EK). PATIENTS AND METHODS: A total of 181 patients with chronic tonsillitis or tonsillar hypertrophy were stratified in terms of patient characteristics and randomized before undergoing tonsillectomy. The follow-up period continued until postoperative day 20. RESULTS: FS-treated patients reported lower postoperative pain intensity scores (p = 0.011) and significantly reduced pain duration (p < 0.001). Whilst wound healing appeared to be improved in FS patients, the rates of postoperative hemorrhage remained unchanged. Use of an FS enabled inexperienced surgeons (< 100 procedures) to reduce their operating time by 8 min (p = 0.05), although no effect was observed for experienced surgeons. CONCLUSION: Hemostasis is effectively mediated by an FS and its application reduces postoperative pain intensity and duration. Although we observed accelerated wound healing and reduced operating times owing to a more calculable rate of hemostasis, this did not influence the rates of postoperative hemorrhage.

[Impact of transtympanic miniature endoscopy of the middle ear--a conceptual cadaver study]. / Wertigkeit der transmyringealen Mini-Endoskopie des Mittelohres--Eine konzeptionelle Kadaver-Studie.

OBJECTIVE: Endoscopic inspections of the middle ear have already been described. So far, the low optical quality due to the small diameter is limiting this type of procedure. In this study the use of a miniature endoscope for visualization of the middle ear structures has been evaluated. MATERIAL AND METHODS: 8 human cadaveric head specimens have been inspected. Following myringotomy, 2 miniature endoscopes were placed into the middle ear and the promontory, the incudostapedial joint, the round und oval window niche with stapes footplate were visualized and fotodocumentated. After endaural approach all middle ear structures were visualized microscopically and the quality of pictures was compared. Technical picture quality and anatomical visualization were evaluated by 5 ear surgeons. In addition, 2 interventional procedures were performed (control of ossicular chain mobility and intratympanic substance application). RESULTS: Still, the technical picture quality was significantly better for the microscope. The anatomical visualization of the middle ear structures with the miniature endoscope was not inferior compared to the microscope. The feasibility of additional interventions, e.g. control of ossicular chain mobility or intratympanic substance application could be shown. An inspection of the correct prosthesis position after tympanoplasty could be evaluated, too. CONCLUSION: This study showed that middle ear structures can be visualized by trans-tympanic miniature endoscopy equal or even better compared to conventional microscopy in spite of reduced technical quality.

[Translational approaches in cancer stem cell research]. / Translationsansätze in der Tumorstammzellforschung.

There has been a growing body of evidence in recent years to indicate that the presence of cancer stem cells may be responsible for tumour development and early recurrence after conventional therapy strategies such as surgery, radiation, or chemotherapy. Although this concept of a small subpopulation of cancer cells with stem cell properties is not new as such and was already discussed by Virchow decades ago, the identification of cells of this kind in human malignancies was first successful in 1997 in acute myeloid leukemia. The recent identification of cancer stem cells and the detection of their fundamental signalling pathways (e.g. Hedgehog, Notch) may offer new therapeutic options in the future and become part of a therapeutic concept. In this article, we introduce the cancer stem cell model, provide an overview of current cancer stem cell markers in different human malignancies as well as head and neck squamous cell carcinoma, and discuss studies on the first targeted therapies against cancer stem cells and their signalling pathways.

[Current therapy options in recurrent head and neck cancer]. / Aktuelle Therapieoptionen bei rezidivierenden Kopf-Hals-Tumoren.

Recurrent disease is one of the main reasons for the persistently poor prognosis of squamous cell carcinoma of the head and neck (HNSCC; European 5-year survival, 42%). The main treatment option for primary and secondary malignancy as well as recurrent disease is surgical therapy. If R0 resection (resection margin >5 mm) for a primary tumor is not viable, survival probability is reduced by 50%. In recurrent or secondary tumors with R1- or -2 resection or in the presence of non-resectable metastases, a palliative situation results in more than 80% of cases. In the case of surgery following radiotherapy or radiochemotherapy, attention should be paid to the criteria for salvage surgery (tissue perfusion, fibrosis, wound healing) and the procedure adapted to focus on functionality. In the case of relapse, primary surgery can potentially be supplemented with adjuvant therapy protocols such as (re-) irradiation, as well as possibly with chemotherapeutic agents or targeted therapies. Interdisciplinary collaboration and case discussions should take place in the context of a tumor board.

[Current recommendations of dacryocystorhinostomy]. / Aktuelle Empfehlungen zur Dakryozystorhinostomie.

UNLABELLED: CURRENT RECOMMENDATIONS OF DACRYOCYSTORHINOSTOMYOBJECTIVE: With the implementation and the development of endoscopic systems, especially in functional endoscopic sinus surgery (FESS) in the last two decades, the gold standard considered external dacryocystorhinistomy (DCR) by Toti in patients with an obstruction of the lacrimal sac or the nasolacrimal duct has been replaced more and more by endonasal techniques. The endonasal approach, first performed in 1893 by Caldwell and publiciced by West 1911, has been modified since than, reached increasing acceptance and is nowadays often performed be ENT surgeons and ophthalmologists. MATERIAL AND METHODS: This review article presents the possible reasons of an obstruction of the lacrimal sac or the nasolacrimal duct with consecutive epiphora or recurrent dacryocystitis, describes diagnostic procedures and indications of therapy, and tries to demonstrate the surgical change towards endoscopic endonasal techniques. We compare both operation techniques and discuss their advantages with the focus on the endonasal approach. The relevance of additional adjuvants described in literatur (laser, use of mitomycin or fluoruracil or silicon intubation) are presented and discussed, too. RESULTS: At the end we discuss the published results of both techniques (endonasal vs. external DCR) and compare their success rates. In spite of the tendency towards endonasal endoscopic techniques the results of this approach seem to be a little worse in comparison to the results after external DCR.

[Therapeutic options in sinunasal adenoid cystic carcinomas--a case report and review]. / Behandlungsstrategie bei sinunasalen adenoidzystischen Karzinomen--Ein Fall mit Literaturübersicht.

BACKGROUND: Adenoid cystic carcinomas (ACC) in sinunasal compartments are often not completely resectable. We discuss both, surgical margins and functional results preoperatively and postoperative options for adjuvant therapy. The former opinion of a resistance of ACC towards chemotherapy or irradiation seems to be outdated, even though consensus about therapeutic strategies is still missing. MATERIAL AND METHODS: We discuss therapeutic options and compare data from literature regarding the best adjuvant therapy with the case of a 25-year-old patient with an advanced ACC of the left fossa pterygopalatina. Further we discuss alternative therapeutic options like neutron irradiation, chemotherapy or targeted therapy. Following the advice from literature, we performed an eye saving tumor resection by a left transmaxilloethmoidale sphenoidectomy via combined trans- und extranasal approach. We accepted close surgical margins for the benefit of the abandonment of dismembering measures and performed an adjuvant radiochemotherapy with taxol and carboplatin. RESULTS: With the described therapeutic strategy we reached an optimal local tumor control with unlimited visus and without functional and cosmetic restrictions up to now. Periodic staging did not show any local tumor progress or metastatic spread hitherto. CONCLUSION: Organ preserving surgery and adjuvant radiochemotherapy even in combination with taxol and carboplatin seems to be a sufficient therapeutic option in treating advanced sinunasal ACC, and might not have any prognostic disadvantages to radical surgery.

[Risk of nanoparticles?]. / Risiken durch Nanopartikel?

Nanotechnology is an "emerging industry" and becomes more widely used. As a result human exposure to nanoparticles is inevitable. Exposure to nanoparticles can affect the upper aerodigestive tract, before particles reach lung, stomach and intestine. The effects of this passage depend on particle size, particle concentration, the kind of the particle and the duration of contact. Only few in-vitro-investigations about effects of the exposition of nanoparticles on the mucous cells of oral cavity, nose and nasal sinuses exist. In-vitro-analysis with cells of nasal mucous membrane exposed to nanoparticles showed a release of mediators involved in inflammation and allergy development. Cytotoxic and genotoxic effects could be found for several nanoparticles (e.g. carbon nanotubes) in vitro. Due to different size, structure, chemical and physical properties nanoparticles can not be summarized in a homogenous group; quite the contrary risk evaluation of nanoparticles must be carried out case-related. Today toxicological risks can not be evaluated sufficiently. Biological interactions and tissue permeability of manufactured nanoparticles is a major issue for further investigations. In this report the use and health effects of nanoparticles are overviewed.

Effect of age and hypoxia/reoxygenation on mRNA expression of antioxidative enzymes in rat liver and kidneys.

The influence of a short-time isobaric hypoxia as well as reoxygenation on markers of oxidative stress (MDA, total SOD, GSH) and on the mRNA expression of the antioxidative enzymes (Cu/Zn-and Mn-SOD, catalase, GSH reductase and GSH peroxidase) has been studied in liver and kidneys of young (6 months) and old (22-25 months) Wistar rats. In livers of old animals, the concentration of GSH, the activity of SOD, and the mRNA expression of the antioxidative enzymes (except Mn-SOD) points to a restricted protection against oxidative stress or a lower production of ROS compared to young animals. Hypoxia resulted in a significant decrease of enzyme gene expression in both age groups. Reoxygenation caused an increase in mRNA of Cu/Zn-SOD and GPX in livers of young and of Mn-SOD in livers of old animals. In kidneys, gene expression of Cu/Zn-SOD, GSH reductase, and GPX was significantly higher in old animals compared to young animals. Whereas hypoxia caused a decrease of gene expression in the livers, it lead to a significant increase of Cu/Zn-SOD, catalase, and GSH reductase mRNA in kidneys of young rats. A reduced gene expression was observed after reoxygenation. In old kidneys, the expression of all enzymes except for catalase progressively declined in the hypoxic and reoxygenation groups. These data show that gene expression of antioxidative enzymes is affected by age and significantly differs between liver and kidney.