[Prevalence of abnormal mucosal findings in patients in HNO practices]. / Prävalenz auffälliger Schleimhautbefunde bei Patienten in HNO-Praxen.

OBJECTIVE: To date, no secondary prevention program is in place for patients carrying an increased risk for developing head and neck cancer (HNSCC). In terms of successful, long-term curative therapy and increased quality of life, it would be useful to detect such diseases at an early stage. PATIENTS AND METHODS: A total of 370 patients with at least one risk factor such as "smoking", "alcohol", or "reflux disease" and without any symptoms were examined during a 1-year period using standard HNO methods (e. g. endoscopy) for suspicious alterations of the mucosa of the upper aerodigestive tract. RESULTS: In 13 (3.5%) of all 370 cases a biopsy was taken for further diagnosis. Squamous cell carcinoma was found in eight cases, while one further patient was suffering from non-Hodgkin lymphoma. CONCLUSIONS: It is simple and safe to examine patients at risk of developing HNSCC by standard HNO methods. The rate of detected carcinomas is much higher than in former investigations, likely because our survey focused only on patients with specific risk factors.

Allergic fungal sinusitis caused by Bipolaris (Drechslera) hawaiiensis.

Depending on the aggressiveness of the pathogen and a patient's immunocompetence, fungal polypoid pansinusitis or allergic fungal sinusitis (AFS) may be a life-threatening disease. Apart from the clinical findings, its diagnosis is based on the demonstration of mucinous material with abundant eosinophils in the paranasal sinuses (indicating an allergic process), cultivation of the causative pathogen and immunocompetence of the patient. In a 20-year-old immigrant Sudanese woman, AFS due to Bipolaris (Drechslera) hawaiiensis was diagnosed. Because of intracranial extension, the disease had led to erosion of the cranial base and orbit with amaurosis on the right side and focal epilepsy. In addition to endonasal microsurgical pansinus operations, local irrigation therapy with amphothericin B was accompanied by systemic treatment with itraconazole after in vitro cultivation of the pathogen and determination of its sensitivities. Interdisciplinary management included a combination of endonasal surgery with debridement of infected tissues and wide drainage of the sinuses without removal of skull bone or the dural lesion in addition to specific antimycotic treatment. Injury to adjacent anatomical structures must be avoided in any case to prevent systemic or possibly lethal dissemination of infection.

[Ion transport in nasal and paranasal sinus mucosa in mucoviscidosis and chronic sinusitis]. / Ionentransporte über die Nasen- und Nasennebenhöhlenschleimhaut bei Mukoviszidose und chronischer Sinusitis.

Cystic fibrosis (CF) is the most commonly inherited disease in Caucasians and is caused by a mutation in the gene encoding a membrane transport protein. This cystic fibrosis transmembrane conductance regulator (CFTR) is thought to be an apical Cl- channel activated by intracellular cAMP. Most recent findings suggest that CFTR is more than a pure Cl- channel and might be involved in the regulation of other transport systems. In the present study we show that CFTR as a Cl- channel plays only a minor role in primary cultured human nasal epithelium derived from non-CF and CF patients. These findings are especially of interest for non-CF human nasal epithelia in which CFTR is correctly inserted. In both tissues Cl- secretion is negligible as compared with Na+ absorption. We confirm and expand our previous observations that Na+ absorption in human nasal epithelium is the dominant ion transport process and that Cl- secretion is detectable in both CF and non-CF tissue. Moreover, we show that cAMP and ATP were not able to stimulate any silent Cl- channels in CF or non-CF human nasal epithelial cells. We further give evidence that in human nasal CF and non-CF epithelium Na+ absorption is mediated by epithelial Na+ channels (ENaC) that are either different from those of other epithelia or which exhibit altered regulation. These differences between Na+ channels of human nasal epithelium and "classical" epithelial Na+ channels include lack of activation by the intracellular second messenger cAMP and the steroid hormone aldosterone. We show further that human nasal Na+ channels are inhibited by Cl- channel blockers and exhibit a different pharmacology towards common Na+ channel blockers.

Significance of autofluorescence for the optical demarcation of field cancerisation in the upper aerodigestive tract.

BACKGROUND: Second primaries in the upper aerodigestive tract (UADT) are increasingly related to bad prognosis. So early detection of small cancer foci is required to improve the survival rate. Here, autofluorescence (AF) might become useful as in vivo biochemical changes of cancer metabolism can be shown by fluorescence. MATERIAL: For more exact data on AF in cancerous lesions 32 cancer specimens of the UADT and 57 specimens of normal oral mucosa as a control group were examined by using autofluorescent microscopy and spectroscopy, the tissue being activated with light at 365 nm wavelength. Video-controlled in vivo fluorescence examinations in field cancerisation of the UADT were also investigated and compared with pathohistological findings. RESULTS: The intensity of AF of the connective tissue was observed to increase at the tumour border. Contrary to results in the literature, no homogeneous fluorescence gradient could be proved between marginal epithelium and the tumour itself. The brightly shining submucosal elastic fibres allowed fluorescent spectroscopic detection of the tumour margins in vitro in 71%. Even small precancerous lesions were traced in vivo mainly by keratinization when using the autofluorescence diagnostic imaging system. CONCLUSIONS: Our examination proved a multi-factorial genesis of autofluorescence with strong inter-individual variations. Preliminary clinical examination showed that this method can be applied as an additional tool for early detection of cancerous lesions in the UADT.

[Benzamil and mucoviscidosis. Primary culture of nasal mucosa as an electrophysiologic in vitro model]. / Benzamil und Mukoviszidose. Primärkultur der Nasenschleimhaut als elektrophysiologisches In-vitro-Modell.

The genetic disease cystic fibrosis (CF) is characterized by a defect in the gene encoding for an epithelial chloride channel. This gene product, cystic fibrosis transmembrane conductance regulator (CFTR), in turn leads to a decreased chloride secretion. When this occurs sodium absorption is increased drastically because of an up-regulation of the epithelial sodium channel. In airway epithelia these changes in ion permeabilities result in dehydration of the mucus blanket and impaired mucociliary clearance, and subsequently lead to chronic infections of the airways. In this study we established a primary cell culture of human nasal epithelium from CF and non-CF patients. The increased transepithelial potential in CF exclusively was due to the greater sodium absorption. In previous studies, amiloride was found to specifically block the epithelial sodium channel. Inhalation of nebulized amiloride has been used clinically in the treatment of CF to inhibit sodium absorption and exert a secondary effect on water withdrawal. In the present cell culture model benzamil, an amiloride analogue, was found to inhibit sodium absorption completely, but at strikingly lower concentrations than amiloride. This raises the possibility of using benzamil for inhalation and to provide better efficacy in the symptomatic therapy of patients with CF.