[From the expert's office. Atlanto-axial subluxation with spastic torticollis after adenoid-ectomy resp. tonsillectomy in rose position - malpractice of the surgeon or the anaesthesiologist?]. / Aus der Gutachtenpraxis: Atlantoaxiale Subluxation mit spastischem Schiefhals (Grisel-Syndrom) nach Adenotomie bzw. Tonsillektomie am hängenden Kopf - Fehler des Operateurs oder des Anästhesisten?

INTRODUCTION: An arbitration board had to decide whether or not there had been a causal connection between an adenoidectomy or resp. a tonsillectomy and an atlanto-axial dislocation and if so whether this was to be considered a case of malpractice. CASE HISTORIES: In two young girls aged 6 and 11 a torticollis had developed 3 resp. 4 days after the operation. In both cases the proper diagnosis was made only after extensive diagnostic procedures including radiology, neurology, neurosurgery and orthopaedics. The findings are presented in detail. In both cases there was a rotary subluxation between cervical vertebrae C1 and C2 due to a retropharyngeal inflammation. Normal function could only be achieved by surgical reposition and the application of a fixateur externe for quite a long period. DISCUSSION: A non-traumatic torticollis is a very rare complication of an adenoidectomy or tonsillectomy, two of the most common surgical interventions in oto-rhino-laryngology. It is known as Grisel's disease because Grisel in 1930 was the first to describe this sequel following nasopharyngitis and tonsillectomy. A detailed review of the literature and a discussion of the underlying pathology is presented. Predisposing factors might be additional local anaesthesia and electro-haemostatis. CONCLUSIONS: : In both cases evidence for malpractice could not be found, neither concerning the intervention itself nor the handling in the postoperative period. The latency of several days between the operation and the manifestation of the torticollis is regarded as proof that intraoperatively there was no malpractice. In cases where the torticollis is present immediately after the intervention, as has been reported in the literature, a traumatic luxation during the operation or positioning of the patient may be taken into consideration. Because of the extreme rareness of the complication it does not seem compulsory to make it part of the preoperative informed consent.

[Video-assisted endoscopic sinus revision for treatment of chronic, unilateral odontogenic maxillary sinusitis]. / Die videoassistierte endoskopische Sinusrevision zur Therapie der chronischen einseitigen dentogenen Sinusitis maxillaris.

BACKGROUND: The proportion of dental causes of maxillary sinusitis is estimated between 10% and 40%. The mechanisms are manifold and originate from the close relation of the side teeth and the maxillary sinus. In the past, the transantral approach was commonly used by maxillofacial surgeons as their first choice. PATIENTS AND METHODS: Between 01/1999 and 10/2001 38 patients underwent endoscopic surgery controlled via the fossa canina. Apart from the mandatory treatment of the dental focus and the mucosal pathologies, a fenestration to the middle meatus of the nose was performed in 7 cases. RESULTS AND CONCLUSION: The dental medical history, OPG, CT scans in coronary plane, endoscopic findings, and histology showed the commonly "silent" course of dental sinusitis. Typical findings in CT scans are unilateral basal maxillary opacities adjacent to the molar and premolar teeth. In 20% of the cases there was also a blockade of the infundibulum. All patients were reexamined 6-12 months postoperatively. The patients are free of symptoms, but sometimes suffer from headaches. An exact diagnosis and the clear separation of rhinogenic causes are vital points for the therapy of dental sinusitis. In cases of unilateral sinusitis, a comprehensive investigation by the maxillofacial surgeon should be recommended. Video-assisted endoscopic sinus revision is preferable to the transantral approach and is especially suitable for the treatment of mucosal retention cysts, the removal of foreign bodies, endoscopically controlled resections of apical roots, elevations of the sinus floor, and dental implants. If the ethmoidal infundibulum and maxillary ostium are open, no fenestration is needed. In cases of blockade, fenestration to the middle nose canal is indicated.

[Cytoprotection with amifostine in the framework of radiochemotherapy in previously irradiated head and neck carcinoma]. / Zytoprotektion mit Amifostin im Rahmen der Radiochemotherapie bei vorbestrahlten Kopf-Hals-Karzinomen.

PURPOSE: The radiotherapeutic possibilities are limited for patients with a recurrent or second head and neck cancer if the patient was already irradiated in the first therapy. In the presented study we investigated the changes of this situation due to the usage of amifostine in the case of re-irradiation (simultaneous radio-chemotherapy). PATIENTS AND METHODS: Between 1995 and 1997 we treated 14 patients with a recurrent or second malignancy of the head and neck region by a simultaneous radio-chemotherapy (20 x 1.5 Gy, Carboplatin 70 mg/m2 BSA on days 1 to 5 and 16 to 20, 500 mg amifostine prior to every carboplatin infusion). Six out of 14 patients got an additional brachytherapy (10 to 15 Gy) to increase the local dose because of a residual tumor. In 4 cases the treatment was an adjunctive one, following the surgical tumor debulking. RESULTS: We have seen 3 complete remissions (21.4%), and 8 partial remissions (57.1%). The median time of observation is 13 months now. Three out of 14 patients died, 2 because of the tumor. Hematological toxicities: side effects Grade 2 WHO were seen only in 1 patient. Acute non-hematological toxicities: mucositis Grade 0/1 in 7 patients, mucositis Grade 2 in 7 patients, dysphagia Grade 0/1 in 9 patients, dysphagia Grade 2 in 5 patients, xerostomia Grade 1 in 9 patients, xerostomia Grade 2 in 3 patients. We registrated only 1 serious late toxicity due to radio-chemotherapy: 4 months after brachytherapy a patient (with laryngectomy) developed a submental fistula. CONCLUSION: These first results suggest that the usage of amifostine offers new potential ways for re-irradiation of patients with recurrent or second malignancies in the head neck region.

Chemoprevention with interferon alfa and 13-cis retinoic acid in the adjunctive treatment of head and neck cancer.

BACKGROUND: Retinoids have been increasingly used since the mid-1960s for the treatment of leukoplakia and dysplasia of the head and neck. Studies of their use in the treatment of carcinomas of the head and neck, usually in combination with interferons, have also been published in recent years. METHODS: 30 patients (25 men, five women) with UICC stage IV were given adjunctive treatment with a combination of 3 x 3 million IU of interferon alfa SC weekly and 0.5 mg/kg body weight of 13-cis retinoic acid PO daily for a maximum duration of 6 months. The therapeutic benefits and side effects are reported here. RESULTS: Therapy was completed as scheduled in 16 out of 30 patients. Reasons for stopping treatment: progressive disease (ten patients), side effects (four patients). 18 patients were tumor-free following treatment. 16 patients displayed a complete response one year after completion of adjunctive treatment. Retinoic-associated side effects observed included xerostomia (90%), dysphagia (67%), weight loss (50%), flush (50%) and cachexia (7%). Interferon-associated side effects included pyrexia and moderate hematological changes. CONCLUSION: Adjunctive combination treatment with interferon alfa and 13-cis retinoic acid appears to be beneficial to patients with head and neck cancer. The side effects are moderate.

Selective cytoprotection with amifostine in concurrent radiochemotherapy for head and neck cancer.

BACKGROUND: Amifostine has reduced toxicities associated with radiation therapy and platinum-based chemotherapy. In a phase II randomized trial, we investigated the ability of amifostine to reduce the toxicity of carboplatin plus radiotherapy (RCT) in patients with head and neck cancer. PATIENTS AND METHODS: Thirty-nine patients with stage III or IV squamous cell carcinomas of the head and neck received RCT (following surgery or as primary treatment). Radiotherapy was given five days per week with daily fractions of 2 Gy, up to a total dose of 60 Gy in conjunction with carboplatin 70 mg/m2 on days 1 through 5 and days 21 through 26. Eligible patients were randomised to receive RCT alone or preceded by a rapid infusion of amifostine (500 mg) on the days when carboplatin was administered. RESULTS: Patients receiving amifostine + RCT (n = 25) had significantly reduced mucositis (P = 0.0001) and xerostomia (P = 0.0001) in comparison with patients receiving RCT alone (n = 14). Additionally, patients receiving amifostine + RCT had significantly less thrombocytopenia (P = 0.001) and leukopenia (P = 0.001). At 12 months following therapy, 79% of patients receiving amifostine + RCT had no evidence of disease compared with 64% of those receiving RCT alone. CONCLUSIONS: Amifostine reduces the RCT-induced toxicities in patients with head and neck cancer and has no negative impact on antitumour efficacy.

Radiochemotherapy with amifostine cytoprotection for head and neck cancer.

A randomized study was conducted to evaluate the protective activity of amifostine (A) against the dose-limiting toxicities of radiochemotherapy (RCT). Patients with head and neck cancer received radiotherapy (2 Gy/day 5 days a week up to 60 Gy) with carboplatin 70 mg/m2 on days 1-5 and 21-25 inclusive. Patients either received RCT alone (n = 14) or RCT + A at a dose of 500 mg prior to treatment with carboplatin (n = 25). There was a significant reduction in the incidence of grade 3/4 mucositis (P < 0.0001), acute grade 2 xerostomia (P < 0.0001) and grade 3/4 thrombocytopenia (P = 0.012) in these patients who received A. The incidence of grade 2 late xerostomia at 12 months is 16.7% and the incidence of loss of taste is 0% in patients treated with A, as opposed to 54.5% and 63.6% in patients who received RCT alone. There were 18 (72%) complete responses (CR) and 6 (24%) partial responses (PR) in patients who received A, compared with 6 (43%) CR and 6 PR (43%) in patients treated with RCT alone. The disease-free survival at 12 months is 85.7% in the RCT + A arm and 78.6% in the RCT alone arm. The use of amifostine reduces the incidence and severity of acute and late toxicities associated with RCT whilst preserving antitumour activity.

Effects of mating structure in purebred populations on the estimation of crossbreeding parameters.

SUMMARY: Usually a simple additive-dominance model is considered to be adequate for the explanation of the genetic basis of heterosis. From this model a linear relationship is expected between the heterosis and the degree of heterozygosity of crossbreds. Assuming Hardy-Weinberg equilibrium in parental populations, the increase in heterozygosity of the F1-generation can be calculated from the squared difference of the parental allele frequencies. This increase is halved in secondary crossbred generations such as F2 or backcrosses. If the parental generations are subdivided into subpopulations, there will be a deficit of heterozygous genotype frequencies at a locus compared to the Hardy-Weinberg proportions, whereas the allele frequencies for the population as a whole remain unchanged. Therefore, for most traits the mean of such a subdivided population is expected to be reduced due to inbreeding depression. When two parent populations structured into subunits are crossed, the reduction of heterosis in advanced crossbred generations will not follow the classical additive-dominance model. The results of crossbreeding experiments with structured parent populations may then cause misleading genetic interpretations and may lead to wrong decisions concerning the expected efficiency of crossbreeding programmes. The paper deals with the parametrization used to describe the performance of crossbred generations when reversible inbreeding due to subdivided parental populations is present. To combine the effects of inbreeding and crossbreeding in a comprehensive model, the genetic model of Dickerson (1969) was extended by a direct inbreeding parameter and an epistasis parameter in backcross generations. This extended model was checked by a crossbreeding experiment with the Japanese quail. ZUSAMMENFASSUNG: Auswirkungen der Paarungsstruktur von Reinzuchtpopulationen auf Schätzwerte von Kreuzungsparametern Im allgemeinen wird für die Interpretation von Heterosis ein einfaches Additiv-Dominanz-Modell als geeignet angesehen. Danach wird bei Kreuzungen eine lineare Beziehung zwischen Heterosis und Heterozygotiegrad erwartet. Wenn in den Elternpopulationen ein Hardy-Weinberg-Gleichgewicht unterstellt wird, ergibt sich der Heterozygotiezuwachs der F1-Generation aus der quadrierten Differenz der elterlichen Allelfrequenzen. In sekundären Kreuzungsgenerationen wie F2- und Rückkreuzung wird dieser halbiert. Wenn die Elterngenerationen in Subpopulationen unterteilt sind, ist für einzelne Loci der Anteil der heterozygoten Genotypen gegenüber dem Hardy-Weinberg-Gleichgewicht reduziert, wobei die Allelfrequenzen in der Gesamtpopulation unverändert bleiben. Für die meisten Merkmale ist deshalb für eine solche Population eine auf Inzuchtdepression beruhende Reduktion des Mittelwertes zu erwarten. Wenn zwei auf diese Weise strukturierte Elternpopulationen gekreuzt werden, entspricht die Reduktion der Heterosis in weiterführenden Kreuzungsgenerationen nicht dem klassischen Additiv-Dominanz-Modell. Die Ergebnisse von Kreuzungsexperimenten mit strukturierten Elternpopulationen können dann irreführende genetische Interpretationen verursachen und zu falschen Schlußfolgerungen im Hinblick auf die Effizienz von Kreuzungsprogrammen führen. Die Arbeit befaßt sich mit der Parametrisierung des Leistungsniveaus von Kreuzungsgenerationen, wenn eine durch Unterteilung der Elternpopulationen verursachte reversible Inzucht vorliegt. Das genetische Modell von Dickerson (1969) wurde durch einen Parameter für Inzucht und einen für Epistasie in Kreuzungsgenerationen erweitert. Das erweiterte Modell wurde durch ein Kreuzungsexperiment mit japanischen Wachteln überprüft.

[Early auditory evoked potential. A diagnostic parameter in uremic encephalopathy]. / Das frühe akustisch evozierte Potential. Ein diagnostischer Parameter der Urämischen Enzephalopathie.

The brainstem auditory evoked responses (BAERs) of 87 patients with chronic renal failure (average age 51 years) were examined according to serum creatinine levels, the nature of the chronic renal disease present and the effect of dialysis. Changes recorded were followed over a period of 3 years. Altogether BAERs of 272 ears were evaluated. Results demonstrated changes in wave morphology and abnormal prolongations of all wave latencies and interpeak intervals. Wave V latencies and the interpeak interval for waves I-V showed a correlation to serum creatinine levels. The direct positive effect of dialysis was reflected in shortening of all wave latencies. The nature of the chronic renal disease and the existence of coexistence diseases were not important for changes in central BAER responses. The recording of the intra-individual course of a BAER permitted documentation of worsened cerebral function even in patients with constant uremic conditions.

[Follow-up of mastoiditis and mastoidectomy]. / Spätergebnisse nach Mastoiditis und Mastoidektomie.

BACKGROUND: To analyse the late results of mastoiditis and operative intervention as well as critical classification of our own indication for operation we invited 298 operated patients to follow-up examinations. PATIENTS AND METHODS: 218 of 298 patients operated on, took part in these examinations. The follow-up time ranged between 2 and 18 years. RESULTS: Altogether 311 ears were operated. Out of these, 69 patients had presented with classical mastoiditis and 242 with "masked" type. Microscopic examination of the operated ears showed that 284 (91.3%) had normal tympanic membranes, 13 (4.2%) had central tympanic membrane perforations with mucosal inflammation and 14 (4.5%) had residual retraction pockets or attic cholesteatomas. Hearing tests showed that 242 (77.8%) were normal, 56 (18%) had conductive deafness (with 32 of these ears having normal tympanic membranes), 10 (3.2%) had sensorineural deafness and 3 (1%) combined deafness. Schüller's radiographic views demonstrated compact mastoid processes in 48.7% of the reexamined ears and re-pneumatisation in 53%. CONCLUSION: The presented data of our re-examinations support our principle that prompt surgical treatment of all forms of mastoiditis is imperative.

[Possible applications of brachytherapy from the viewpoint of the ENT physician]. / Einsatzmöglichkeiten der Brachytherapie aus der Sicht des HNO-Arztes.

BACKGROUND: Surgery, conventional radiation therapy, and chemotherapy are established methods of treating patients with head and neck cancer. Conventional radiation therapy is often ineffective in treating recurrent tumors. Modern methods of interstitial and intracavitary brachytherapy change this view. METHODS AND PATIENTS: In our series of 37 patients with recurrent head and neck cancer, we encountered no technical difficulties in placing indwelling catheters, needles, or applicators. We treated tumors of the nose, epipharynx, tongue, base of the tongue, trachea, esophagus, and cervical lymph nodes. In these patients, we successfully irradiated the tumor with doses up to 30 Gray. A case history is presented to demonstrate the combined action of intratumoral interferon alfa injection and interstitial brachytherapy on a tumor of the base of the tongue. RESULTS: Total remission rate 32/36 patients, 14 complete remission, 18 partial remission. Main complications were bleeding in one patient due to a vascular lesion and fistula formation. CONCLUSION: Brachytherapy is well suited for treating recurrent tumors of the head and neck region in individual patients.

[Value of megestrol acetate in treatment of cachexia in head-neck tumors]. / Stellung des Megestrolacetates in der Behandlung der Kachexie bei Kopf-Hals-Tumoren.

Mortality of 70% of all patients with tumors in the head and neck is linked with anorexia and cachexia. Two reasons for cachexia are well known: 1. local disease and local therapy preventing oral nutrition and 2. advanced tumors activating biochemical pathways of proteolysis, lipolysis, and gluconeogenesis. Five groups of substances are now used to treat tumor-induced cachexia: corticosteroids, progestational drugs, cyproheptadine, hydrazine sulfate, and anabolic steroids. Between 1992 and 1993 we treated 38 patients suffering from cachexia due to advanced cancers of the head and neck with 160 mg megestrol acetate per day for four months. The increase in body weight was significant after eight weeks. The mean increase after full therapy was 4.58 +/- 3.19 kg. Treatment of the five women in the series was very successful and all achieved their former body weight. Megestrol acetate therapy was best started after assuring enteral nutrition. Significant adverse events were loss of libido for the men, headache and, rarely, thrombophlebitis. Our first experiences suggest that megestrol acetate treatment is useful in cachectic patients with advanced squamous cell carcinomas of the head and neck.

[Metabolism of articular cartilage in the presence of interleukin-I alpha, its inhibitor and blood serum]. / Metabolizm sustavnogo khriashcha v prisutstvii interleikina-I al'fa, ego ingibitora i syvorotki krovi.

The study was made of the effect which interleukin receptor antagonist protein (IRAP) and bovine serum have on interleukin-1 alpha (IL1a) activity in cartilage culture of young bulls. It was established that IL1a leads to cartilage degradation as shown by an increase of sulphated glycosaminoglycans (sGAG) in culture medium and their decrease in tissue, inhibition of proteoglycan (PG) synthesis by chondrocytes. This effect of IL1a is suppressed by IRAP. In serum-free culture the cartilage tissue produced proteoglycans in much less quantities. In these conditions IL1a stimulated chondrocytes, cytokine did not respond to IRAP.

[Functional endoscopic ethmoid bone revision in inflammatory paranasal sinus diseases in childhood]. / Funktionelle endoskopische Siebbeinrevision bei entzündlichen Nasennebenhöhlenerkrankungen im Kindesalter.

A total of 57 children aged between 5 and 15 years underwent endoscopic ethmoid surgery for recurrent acute or chronic rhinogenic sinusitis, chronic sinusitis associated with bronchial asthma or chronic bronchitis, early rhinogenous orbital complications and paranasal sinus disease associated with mucoviscidosis. The indications for surgical intervention are based on symptoms, the findings on nasal endoscopy and a CT scan of the paranasal sinuses in the coronal plane. The preoperative examination shows that in childhood there are endoscopically detectable anatomical variations of the ethmoid bone (pneumatised middle nasal concha, reversed curvature of the middle turbinate and contact between the uncinate process and the turbinate) that create the conditions for the development of inflammatory paranasal sinus diseases. Careful elimination of these obstructions can accomplish complete cure of the inflammation, and early orbital complications can be treated effectively by combination of surgery with infusion of antibiotics. All surgery was performed under endotracheal anaesthesia using the endoscopic technique described by Messerklinger. The follow-up period was between 6 and 18 months. With the exception of children suffering from mucoviscidosis, cure of the paranasal sinus disease and rhinomanometrically demonstrable improvement of the nasal breathing was achieved in all cases. On the basis of our results a conservative endoscopic approach is recommended as an effective surgical method for the treatment of paranasal sinus disease in childhood.

[Changes in the early auditory evoked potentials during premature infancy, infancy and early childhood]. / Zu Veränderungen des frühen akustisch-evozierten Potentials zwischen Frühgeborenenperiode, Säuglings- und Kleinkindesalter.

We report on the derivation of the early acoustic evoked potentials (EAEP) in 498 healthy normotrophic infants between the 32nd post-conceptional week and the end of the 3rd year of life. The changes of the wave latencies and interpeak intervals in different age periods until they reached the constant values found in adults are followed by 1528 potential derivations. The varying rate of maturation of the auditory pathway in the brain stem can be followed up well by the potential patterns. The time around the 34th post-conceptional week is characterized by a maturation episode of central and peripheral auditory pathway portions. The extrauterine matured normotrophic preterm infant shows statistically significantly longer latencies of waves III and V and a longer interpeak interval I-V in comparison with normotrophic term neonates. Gestational age, birth weight and Apgar score of the preterm infant had no influence on the behaviour of the EAEP. After the 38th post-conceptional week practically only the maturation of the central auditory pathway portion takes place: the main portion of the latency shortenings of III and V and IPI I-V is applicable to the 1st year of life. The maturation is an individually characterized progressive process of varying speed with no fixed age for its completion. Thus the adult wave V latency was reached in 8% of the 4- to 6-month-old children, and in 57% by the end of the 1st year of life. The adult IPI I-V values were reached in 42% of the 10- to 12-month-old children.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnostic value of the early auditory evoked potentials in acute cranio-cerebral trauma in children]. / Zum diagnostischen Stellenwert des frühen akustisch evozierten Potentials beim akuten Schädel-Hirn-Trauma im Kindesalter.

The brainstem auditory evoked potentials were recorded in 54 children within the first 48 hours after a head trauma of different degree. In comparison with an age--appropriate standard group there are changed BAEP in 51% of the examined children after head trauma. The abnormalities mainly consist in changes of the wave--morphology, the latencies of the waves 1, 3 and 5 were significantly prolonged. The interpeak--intervals only unessentially differ from the standard group. The detected BAEP--changes are of different kind and incidence. A typical change of the potential for the infantile head trauma cannot be found. The regression of the traumatically conditioned BAEP--changes begins during the first days after trauma and it is finished within 6 months in half of the children. In the particular case changes can be detected after two years yet.

[Growth patterns of juvenile nasopharyngeal fibromas. A histological analysis on the basis of 40 cases]. / Wachstumsmuster juveniler Nasenrachenfibrome. Eine histologische Analyse an Hand von 40 Fällen.

Juvenile nasopharyngeal angiofibroma is a unique process characterized by an exclusive localization in the nasopharynx of young male patients, and a typical histological pattern composed of angiomatous and fibrous structures. Forty tumors of patients 7 to 25 years of age were investigated. The tumors showed a characteristic zonal organization. Apart from the superficial epithelium the lesions can be subdivided into a subepithelial myxoid-fibrous zone followed by a proliferative capillary fibroblastic cambium layer. In the latter, either the capillary component or the fibroblasts can prevail. The main part is composed of sinus-like vascular channels and a fibrous component. The gaping vascular channels differing in caliber are lined by a single layer of epithelium and surrounded by single or mostly an incomplete rim of smooth muscle cells. Elastic fibres are always lacking. The fibrous component exhibits a changing cellularity and fibre content. Myxoid foci can be encountered, often associated with a pleomorphic cell pattern. Generally, however, fibre structures and foci or large areas of hyalinization predominant in direction to the central parts. In older lesions the fibrous tissue is prevailing. The capillary fibroblastic cambium zone disappears and areas of hyalinization are enlarged. In five cases relapses showing the same structural features were observed. Juvenile nasopharyngeal angiofibromas are discussed as a specific but non-autonomous proliferating growth process which is characterized by 1. specific age and sex incidence, probably in relation to hormones, 2. typical histological pattern and cytological criteria, including local infiltration of the surrounding musculature and bones, 3. origin in the same region corresponding to the membrana buccopharyngea and constant blood supply by the arteria maxillaris interna, or its end artery, the arteria sphenopalatina. According to the corpus cavernosum-like structures, comparable to erectile tissue, the nasogenital relations are discussed. Juvenile nasopharyngeal angiofibromas are defined as a specific clinicopathological entity.

[Olfactory neuroblastoma. 3 case reports as a contribution to the clinical aspects, morphology and prognosis]. / Das olfaktorische Neuroblastom. Drei Fallbeispiele als Beitrag zur Klinik, Morphologie und Prognose.

The leading symptom in all patients was a nasal obstruction. At first all three cases of olfactory neuroblastoma were mistaken for polyposis nasi. The tumour can be diagnosed solely by histologic examination. The light microscopic as well as the ultrastructural findings demonstrated the great morphological variability of this carcinoma. In nearly all cases a definite diagnosis is possible if besides the light microscopic picture also clinical data, ultrastructural and, if necessary, immunohistochemical findings are considered. At the time of diagnosis one tumour was Kadish-stage A and two were stage C. Lokal and metastatic tumour extension, recurrence of disease after treatment, patient age and radical tumour resection at initial presentation, are prognostic important criteria. The discriminant function by Homzie and Elkon permits the oncologist to predict the patient's outcome accurately.

[Olfactory neuroblastoma. Clinical course, light microscopic and ultrastructural findings in 3 cases]. / Das olfaktorische Neuroblastom. Klinik, Lichtmikroskopie und Ultrastruktur von 3 Fällen.

Olfactory neuroblastomas are considered to be a clinicopathological entity, but they may show variable histologic pictures. The light and electron microscopic features of 3 cases as examples for the possible range of morphological findings are presented. This report is also aimed at defining essential diagnostic features, at discussing the differential diagnosis and finally at making pathologists more familiar with these rare tumors. The clinical appearance of the three cases was more or less typical for olfactory neuroblastomas. The leading symptom in all patients was a nasal obstruction. Light microscopically, the neuroblast-like tumor cells were arranged in sheaths or nests. Only in case 1 there were some Flexner rosettes, and especially in case 2 numerous Homer-Wright pseudo-rosettes could be found. Somewhat spindled cells with resemblance to Schwann cells were recognized in case 1 and 3. Neither argyrophilia nor argentaffinity could be demonstrated. Neuroblast-like tumor cells in case 2 contained glycogen intracytoplasmically. The diagnostically essential electron microscopic characteristics were neurite-like cellular processes and neurosecretory granules within the cytoplasm. Corresponding to light microscopic findings in cases 1 and 3, cells with features of Schwann cells could be identified. From the literature and the results presented here the conclusion can be drawn, that in nearly all cases a definite diagnosis is possible if besides the histologic picture also clinical data and, if necessary, ultrastructural and immunohistochemical findings are considered. The most important light microscopic criteria are a fine-fibrillary intercellular substance and the occurrence of Homer-Wright pseudo-rosettes. The differential diagnosis of olfactory neuroblastomas with special regard to electron microscopic findings is discussed and some remarks on the clinical behaviour are added.

Inverted papillomas of nasal cavity and paranasal sinuses. Ultrastructural investigations on epithelial-stromal interface.

10 cases of inverted papillomas of nasal cavity and paranasal sinuses were examined electron microscopically with particular regard to the epithelial-stromal interface. The papilloma cells were clearly demarcated from the stromal tissue by a basement membrane-like material. However, this structure mainly consisted of two or more layers, occasional breaks in the basement membrane were visible. Within the basal epithelial cells resting on the basement membrane accumulations of actin-like microfilaments could sometimes be observed. Furthermore, in the stromal tissue some myofibroblasts were present in the vicinity of the papillomatous cell complexes and capillary vessels also demonstrated several layers of basement membrane. All the changes presented here are considered to be the result of a permanent interaction between aggressive forces of papilloma cells and the defence mechanism of stromal tissue. The results allow the conclusion that inverted papillomas of nasal cavity and paranasal sinuses are true neoplasms with very low malignancy.