Rare Case of Tularemia With Preauricular Lymphadenopathy and Conjunctivitis in a 27-Year-Old Male Patient in Germany.

Tularemia is a rare disease but shows an approximately 10-fold increase in reported cases over the last 15 years in Germany. Clinical symptoms of acute tularemia infection are various, which often delays diagnosis. This case report gives an overview of the clinical manifestations of acute tularemia and shows the importance of interdisciplinary work to shorten the time from the onset of symptoms to effective treatment in infection with Francisella tularensis. Since some cases of tularemia are life-threatening, early diagnosis is vital. This case report serves as a reminder that rare diseases need to be considered in cervical lymphadenopathy.

[Quality in the appraisal of head and neck sonography results in university hospitals-a random sample]. / Qualität in der Befundung von Kopf- und Halssonographien an Universitätskliniken ­ eine Stichprobe.

BACKGROUND: Ultrasound diagnostics are widely used and are standard for radiologists, otolaryngologists, and oral and maxillofacial surgeons in the diagnostic work-up of various pathologies. There is agreement that digital documentation is urgently needed at present to improve and standardize the quality of sonographic documentation. There are more and more publications on the implementation of standardized documentation of findings in imaging diagnostics, including head and neck sonography. OBJECTIVE: The present work aims to determine the quality of routine head and neck sonography findings on a random basis, according to the criteria of the Bavarian Association of Statutory Health Insurance Physicians (KVB) at a selection of German university otolaryngology departments (ENT). MATERIALS AND METHODS: A total of 70 randomly selected anonymized written findings including image documentation from seven ENT departments were retrospectively analyzed by an experienced KVB examiner concerning fulfilment of KVB criteria. The data were evaluated descriptively. RESULTS: Of the 70 reports, 69 were eligible for evaluation. The average documentation completeness was 80.6%. A total of 9 findings were correctly documented in full (13%). The documentation completeness of the individual departments was sorted in ascending order from 68.1% to 93%. With 88.5% vs. 75%, the hospitals with a structured report showed a higher level of completeness. In 75% of the cases the hospitals with structured reports also had digital solutions for reporting and image archiving. CONCLUSION: In general, there is potential for optimization regarding the completeness and quality of routinely prepared head and neck sonography findings at the selected university ENT departments. The implementation of structured reporting masks and the conversion of analogue documentation into digital solutions as well as digital networking with the hospital information systems, picture archiving and communication systems should be promoted. Supervision by senior doctors is required to ensure the quality of findings of inexperienced colleagues and to help to achieve standards in reporting.

A 9-year analysis of transoral laser microsurgery (TLM) of head and neck cancer on their potential suitability for transoral robotic surgery (TORS) for estimation of future TORS-specific caseload.

OBJECTIVE: After that the establishment of transoral robotic surgery (TORS) for head and neck cancer has been adopted in North America, it has also recently been adopted in Europe. In these parts, transoral laser microsurgery (TLM) is widely applied. The aim of the study was to identify the absolute number of operations amenable to TORS at a TORS initiating institution on the basis of all former TLM cases. PATIENTS AND METHODS: All laser surgery procedures from May 2004 to April 2013 (108 months) were initially retrospectively registered; after that, all stage pT1 and pT2 squamous cell carcinomas of the oropharynx, hypopharynx, and larynx were selected. RESULTS: Over a period of nine years out of all TLM cases, there were 45 cases of pT1 and pT2 orohypopharyngeal and supraglottic squamous cell carcinomas, which could have been considered for TORS surgery. With the inclusion of a nowadays-typical TORS indication such as tonsil cancer, 142 cases would have been amendable to TORS. CONCLUSIONS: The indication for TORS would have been made in five of the TLM cases per year. Institutions initiating TORS, which own an intensive TLM experience, are encouraged to TORS indications in more than solely typical TLM indications. By indicating TORS instead of handheld surgery, a higher caseload of more than 15 cases per year can be achieved for TORS indications.

The Erlangen Questionnaire: a new 5-item screening tool for obstructive sleep apnea in a sleep clinic population - A prospective, double blinded study.

OBJECTIVE: The aim of this study was to develop and validate a simplified screening tool for identifying obstructive sleep apnea (OSA) in a sleep clinic population. PATIENTS AND METHODS: A total of 160 patients from a sleep clinic population was enrolled in the prospective, double-blinded study. OSA was defined by using diagnostic criteria of the ICSD-3 after overnight polysomnography (n=96) or polygraphy (n=64). The first 60 patients filled out a multi-item questionnaire and formed the development group. Subsequently, the five most predictive factors were selected to create the Erlangen Questionnaire (EQ). For validation of the EQ, the next 100 patients formed the validation group. RESULTS: The following factors were incorporated into the 5-item EQ: (1) ESS > 10, (2) age > 60, (3) gasping and (4) cardiovascular risk factors, (5) witnessed apneas. The EQ had sensitivities of 94.3%, 92.7% and 92.3%, specificities of 50.0%, 33.3% and 22.9%, positive predictive values of 81.5%, 62.9% and 29.6%, and negative predictive values of 78.9%, 78.9% and 89.5% with respect to mild, moderate and severe OSA. CONCLUSIONS: EQ is a compact 5-item-based, concise and easy-to-use screening tool to identify both male and female patients with OSA in a sleep clinic-population and exhibits all essential factors of internal and external validity. The results of the EQ are comparable to the best-validated and most commonly used STOP-Bang questionnaire regarding sensitivity and specificity in a sleep clinic population.

Microcystic adnexal carcinoma (MAC)-like squamous cell carcinoma as a differential diagnosis to Bell´s palsy: review of guidelines for refractory facial nerve palsy.

BACKGROUND: Bell´s palsy is the most common cause of facial paralysis worldwide and the most common disorder of the cranial nerves. It is a diagnosis of exclusion, accounting for 60-75% of all acquired peripheral facial nerve palsies. Our case shows the first case of a microcystic adnexal carcinoma-like squamous cell carcinoma as a cause of facial nerve palsy. CASE PRESENTATION: The patient, a 70-year-old Caucasian male, experienced subsequent functional impairment of the trigeminal and the glossopharyngeal nerve about 1½ years after refractory facial nerve palsy. An extensive clinical work-up and tissue biopsy of the surrounding parotid gland tissue was not able to determine the cause of the paralysis. Primary infiltration of the facial nerve with subsequent spreading to the trigeminal and glossopharyngeal nerve via neuroanastomoses was suspected. After discussing options with the patient, the main stem of the facial nerve was resected to ascertain the diagnosis of MAC-like squamous cell carcinoma, and radiochemotherapy was subsequently started. CONCLUSION: This case report shows that even rare neoplastic etiologies should be considered as a cause of refractory facial nerve palsy and that it is necessary to perform an extended diagnostic work-up to ascertain the diagnosis. This includes high-resolution MRI imaging and, as perilesional parotid biopsies might be inadequate for rare cases like ours, consideration of a direct nerve biopsy to establish the right diagnosis.

S100B in serum and saliva: a valid invasive or non-invasive biomarker in obstructive sleep apnea?

OBJECTIVE: The aim of this prospective study was to determine whether serum or saliva S100B could be established as an invasive or non-invasive biomarker of cerebrovascular stress due to chronic intermittent hypoxia in obstructive sleep apnea (OSA). PATIENTS AND METHODS: S100B levels in serum and saliva were measured by an enzyme-linked immunosorbent assay (ELISA) in 40 patients with polysomnographically confirmed OSA (n=34) or ronchopathy (n=6) and 20 control subjects (n=20). We also investigated four healthy volunteers (n=4) to determine whether the S100B levels in serum and saliva are dependent on the time of day. RESULTS: Serum S100B was significantly higher in OSA than in healthy control subjects (p=0.007), although it was not related to the severity of OSA and was independent of age, sex, and subjective daytime symptoms. Values of S100B in saliva showed a marked scatter, so there was no significant difference between the OSA group and controls (p=0.62). We did not find that S100B levels in either serum or saliva depended on the time of day (p=0.53; p=0.91). CONCLUSIONS: Serum S100B allows us to discriminate healthy subjects from patients with OSA. However, it does not live up to its promise as a valid invasive predictor of OSA, since it does not correlate with the severity of the disease. Also, S100B in saliva is not suitable for use as a non-invasive biomarker to detect hypoxia-induced cerebrovascular stress in OSA. This finding prevents an S100B saliva-based assessment of risk or possible extent of structural brain damage, ruling out the possibility of non-invasive home monitoring of compliance and therapeutic efficacy in cases of OSA on treatment.