[Surgical management of persistent diarrhea]. / Chirurgische Therapie einer persistierenden Diarrhö.

An 82-year-old patient presented with a cervical lesion and refractory diarrhea of many years' standing. Surgical therapy of a medullary thyroid carcinoma had been performed 16 years previously. Appropriate tumor follow-up had not been carried out hitherto. Significantly high levels of calcitonin as well as a suspicious octreotide scan indicated late recurrence of the disease. Diarrhea ceased following redo surgery.

Parvovirus B19 detected in Rosai-Dorfman disease in nodal and extranodal manifestations.

Sinus histiocytosis with massive lymphadenopathy (SHML), also designated as Rosai-Dorfman disease (RDD), is a rare benign reactive lymphoproliferative disorder. It is defined by a characteristic histopathology with sinus histiocytosis and haemophagocytosis known as emperipolesis. In histiocytes S100 is strongly expressed, whereas CD1a staining typically is negative. The disease mainly manifests at a single lymph node; however, multilocular and extranodal affection can occur. Causative infectious agents, and virus infections in particular, have repeatedly been suspected, although until now the origin of the disease has been unclear. Four cases of RDD (two nodal sites and two extranodal upper respiratory tract sites) were analysed for parvovirus B19 (B19) infection by immunohistochemistry to detect B19 capsid proteins VP1/VP2. In all the four cases, huge numbers of B19-positive cells were partly detected. The positive cells were identified either as lymphocytes or, in one extranodal case, also as respiratory epithelial cells. This is the first report of B19 infection in RDD tissue, indicating that B19 may be associated with the pathogenesis of SHML.

[Serum concentrations of soluble adhesion molecules sICAM-1 and sVCAM-1 in patients with malignant ENT tumors]. / Serumkonzentrationen der löslichen Adhäsionsmoleküle sICAM-1 und sVCAM-1 bei Patienten mit malignen HNO-Tumoren.

BACKGROUND: Adhesion molecules are implicated in various stages of tumor progression and metastasis. Soluble forms of intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) were recently described. The aim of this study was to determine a differences in concentration of these molecules in patients with head and neck squamous cell carcinoma (HNSCC) compared to healthy controls. PATIENTS AND METHODS: We investigated the circulating levels of sICAM-1 and sVCAM-1 in sera from patients with various head and neck squamous cell carcinomas (n = 52) as well as from normal, healthy controls (n = 35). Serum concentrations were determined as serum immunoreactivity by using a quantitative sandwich enzyme immunoassay technique. For statistical analysis, the Student's t-test was performed. RESULTS: The majority of the patients with HNSCC were found to have high concentrations of sICAM-1 and sVCAM-1. The mean level of sICAM-1 in patients was 313 ng/ml and in the control group 237 ng/ml (p = 0.0005). The mean level of sVCAM-1 in patients was 624 ng/ml and in the control group 435 ng/ml (p = 0.009). The concentrations of sICAM-1 and sVCAM-1 were significantly higher in HNSCC patients. CONCLUSIONS: These results show the difference in expression of these adhesion molecules in patients with HNSCC compared to healthy controls. Endothelial adhesion molecule determination may find clinical applications in the follow-up of cancer therapy. For this reason, studies incorporating the longitudinal follow-up of patients are required.

[Nitinol stent implantation in benign esophagotracheal fistula]. / Nitinolstentimplantation bei benigner ösophagotrachealer Fistel.

The self-expanding nitinol stent is easy to handle and well tolerated. It offers an improved method in the treatment of perforations of the upper aerodigestive tract. It is easily implantable with rigid and flexible endoscopes. A 45-year-old female patient developed a tracheal necrosis after polytrauma and protracted intubation and ventilation. The permanent cuff pressure caused a 5-cm long fistula located at the posterior trachea 3 cm above the carina. After stabilization of the general condition and spontaneous reduction of the fistula length to 2 cm, we implanted the silicon-covered esophageal stent. Daily bronchoscopic examination was done before and after implantation of the stent. Two days after implantation, we were able to remove the blocked tracheostomy tube. Immediately oral nutrition was possible without complications. Because of its easy and fast application without any complications, the new type of nitinol stent is a promising alternative for ear, nose, and throat patients in bad general condition to provide fast and safe treatment in benign tracheoesophageal fistulas.

Inverse association between endogenous glucocorticoid secretion and L-selectin (CD62L) expression in trauma patients.

Exogenously administered glucocorticoids downregulate inflammatory host response, i.e. by inhibition of adhesion molecule expression on leukocyte surfaces. Here, possible associations between the trauma-induced endogenous secretion of cortisol and the expression of neutrophil adhesion molecules (L-selectin/CD62L, CD 11b, CD54) were studied in humans. Standardized elective hip arthroplasty was investigated as an exemplary condition of acute inflammation. In 20 patients, blood for quantification of cortisol and adrenocorticotropic hormone was obtained at minutes 10, 20, 30, 60, hours 1, 2, 4 and 10 and days 1,3 and 7. Expression of L-selectin/CD62L, CD11b and CD54 on neutrophil surfaces was determined preoperatively, and postoperatively at hours 1, 2, 3, 4, and 10 and at days 1 and 3. Secretion of both, adrenocorticotropic hormone and cortisol was significantly increased between 1-10 hours after onset of tissue injury. Compared to baseline values, CD11b expression was increased at hour 1 and normalized after day 1, whereas L-selectin/CD62L expression, mirroring this pattern was decreased until day 1. Patients with high endogenous glucocorticoid secretion exhibited significantly decreased expression selectively of L-selectin/CD62L. However, we also observed that glucocorticoids do not directly induce L-selectin shedding from neutrophil surfaces in vitro, arguing for more indirect glucocorticoid action on adhesion molecule expression. Together, this study showed that increased endogenous cortisol secretion is associated with lower expression of L-selectin on neutrophil surfaces in humans that is consistent with a downmodulating role of this neuroendocrine stress response in inflammatory leukocyte recruitment.

Adhesion molecules in tissue injury: kinetics of expression and shedding and association with cytokine release in humans.

Adhesion molecules are responsible for leukocyte recruitment in injured tissues. Here, the kinetics of expression and shedding of endothelial (sE-selectin-1, sP-selectin, and sICAM-1) and neutrophil (CD11b, CD62L, and CD54) adhesion molecules was investigated by serial determinations of serum concentrations in 20 patients with elective hip arthroplasty as an exemplary condition of acute inflammation in humans. Changes were related to secretion of proinflammatory cytokines (IL-1beta, IL-6, IL-8, and TNF-alpha) as their possible inducing signals. sE-selectin-1 responded to injury with a significant increase in concentrations already after 20 min, followed by sP-selectin and sICAM-1, which increased at Hour 10 and Day 1. Expression of CD11b and CD62L acutely responded to injury (within 1 h) by a parallel increase and decrease, respectively, and normalized by Day 1. Increases in concentrations of IL-1beta and TNF-alpha preceded the increase in adhesion molecules and significantly correlated with the response of sE-selectin-1 and sICAM-1. In conclusion, the close associations between release of IL-1beta and TNF-alpha and sE-selectin and sICAM-1 shown in this kinetic study indicates a key role of these cytokines in upregulation of endothelial rather than neutrophil adhesion molecules in vivo.