Second-line treatment of recurrent HNSCC: tumor debulking in combination with high-dose-rate brachytherapy and a simultaneous cetuximab-paclitaxel protocol.

BACKGROUND AND PURPOSE: After the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates. Effective therapeutic strategies are limited due to the toxicity of previous treatments and the diminished tolerance of surrounding normal tissue. This study demonstrates a promising second-line regimen, with function preserving surgical tumor debulking, followed by a combination of postoperative interstitial brachytherapy and a simultaneous protocol of cetuximab and taxol. PATIENTS AND METHODS: From January 2006 to May 2013, 197 patients with HNSCC were treated with brachytherapy at the University Hospital Schleswig-Holstein Campus Lübeck, including 94 patients due to recurrent cancer. Within these, 18 patients were referred to our clinic because of early progressive disease following first- or second-line treatment failure. They received the new palliative regimen. A matched-pair analysis including recurrent tumor stage, status of resection margins, tissue invasion and previous therapy was performed to evaluate this treatment retrospectively. Overall survival (OS), disease-free survival (DFS), functional outcome and treatment toxicity was analyzed on the basis of medical records and follow-up data. RESULTS: DFS and OS of the study group were 8.7 and 14.8 months. Whereas, DFS and OS of the control group, treated only by function preserving tumor debulking and brachytherapy, was 3.9 and 6.1 months respectively. This demonstrates a positive trend through the additional use of the cetuximab-taxane protocol. Furthermore, no increase of therapy induced toxicities was displayed. CONCLUSION: Pre-treated patients with a further relapse benefit from the 'cetuximab-taxane recurrency scheme'. It seems to be a valuable complement to interdisciplinary and multimodal tumor therapy, which improves OS and results in acceptable toxicity.

[Complex fracture of the larynx caused by a horse kick]. / Komplexe Larynxverletzung durch Pferdetrittverletzung.

Every blunt laryngeal trauma requires examination by an ENT physician and may necessitate observation for a number of hours. The literature shows a heterogeneous picture regarding airway management (tracheotomy vs. intubation). Extremely violence forces such as horse kicks require a tracheotomy, as demonstrated by case studies. In such cases, a high level of responsibility lies with the emergency physician providing the initial treatment. We present the case of a 37-year-old horse trainer, who suffered a horse kick to the larynx with a complex laryngeal fracture. Intubation of the patient by the emergency physician would most probably have led to incorrect placement of the tube or complete displacement of larynx and trachea. In addition to securing a vital airway by tracheotomy, a timely reconstruction of the airways, where necessary by employing the temporary insertion of a tracheal stent, is the treatment of choice. The latter therapy should be applied within the first 6 hours following the accident.

Basilar membrane and tectorial membrane stiffness in the CBA/CaJ mouse.

The mouse has become an important animal model in understanding cochlear function. Structures, such as the tectorial membrane or hair cells, have been changed by gene manipulation, and the resulting effect on cochlear function has been studied. To contrast those findings, physical properties of the basilar membrane (BM) and tectorial membrane (TM) in mice without gene mutation are of great importance. Using the hemicochlea of CBA/CaJ mice, we have demonstrated that tectorial membrane (TM) and basilar membrane (BM) revealed a stiffness gradient along the cochlea. While a simple spring mass resonator predicts the change in the characteristic frequency of the BM, the spring mass model does not predict the frequency change along the TM. Plateau stiffness values of the TM were 0.6 ± 0.5, 0.2 ± 0.1, and 0.09 ± 0.09 N/m for the basal, middle, and upper turns, respectively. The BM plateau stiffness values were 3.7 ± 2.2, 1.2 ± 1.2, and 0.5 ± 0.5 N/m for the basal, middle, and upper turns, respectively. Estimations of the TM Young's modulus (in kPa) revealed 24.3 ± 25.2 for the basal turns, 5.1 ± 4.5 for the middle turns, and 1.9 ± 1.6 for the apical turns. Young's modulus determined at the BM pectinate zone was 76.8 ± 72, 23.9 ± 30.6, and 9.4 ± 6.2 kPa for the basal, middle, and apical turns, respectively. The reported stiffness values of the CBA/CaJ mouse TM and BM provide basic data for the physical properties of its organ of Corti.

[ENT emergency treatment and alcohol related head and neck injuries]. / HNO-Notfallversorgung mit besonderem Blick auf die Gruppe alkoholisierter Patienten.

The spectrum of ENT-diseases can differ widely among emergency departments (ED) of different geographic regions. Especially in terms of head and neck trauma a higher number of injuries can be expected in large cities due to alcohol related violence.The ED of a large hospital situated in the center of Hamburg Germany was analysed for ENT-emergency treatments in 2011 retrospectively. Beside usual patient statistics, the study focused on alcohol related injuries with an ENT-surgeon involved. All data were compared to reports by other EDs in Germany and alcohol related costs were approximated for initiation of prevention programs in the future.2 339 ENT-patients were admitted to the ED. 19% of all patients used an ambulance whereas 80% reached the ED by private transportation. The majority of patients were between 21 and 30 years of age. For 143 of all trauma cases alcohol involvement was documented. Subanalysis revealed male dominance and a high use of ambulance transportation.The high number of traumata differs considerably from other ENT studies. One reason is the hospital's close proximity to all time party districts like "Reeperbahn" and the "Port of Hamburg". In those areas high amounts of alcohol ingestion takes place leading to more injuries at the head- and neck region. Theoretically financial resources would be plenty after the initiation of those programs as the severe costs for alcohol related medical treatment would decline.

[Giant papillomas of the tongue and pharynx in focal dermal hypoplasia: a case report]. / Riesenpapillome der Zunge und des Rachens bei fokal dermaler Hypoplasie: Ein Fallbericht.

Focal dermal hypoplasia is a rare congenital syndrome with dominant X-linked mode of inheritance characterized by a wide range of meso-ectodermal anomalies. The clinical variation is great, as explained by the Lyon hypothesis and mosaicism. Findings include skin atrophy along the lines of Blaschko and papillomas. Our case is striking with rapidly-growing giant pharyngeal papillomas which caused dysphagia and required resection.