Prä- und posttherapeutische Larynxbildgebung

Zusammenfassung: Sowohl CT als auch MRT und neuerdings die PET-CT sind unentbehrliche Zusatzuntersuchungen zur Diagnostik und Stadieneinteilung von Tumoren des Larynx. Sie sind der klinischen Untersuchung (einschließlich endoskopischer Biopsie) beigeordnet und ergänzen diese komplementär. Eine sehr genaue Kenntnis der submukösen Tumorausbreitungswege, der diagnostischen Zeichen der Tumorinfiltration und deren Konsequenzen für Stadieneinteilung und Therapie sind unentbehrlich für die Interpretation von CT-, MRT- und PET-CT-Bildern. Sowohl CT als auch MRT sind hochsensitive Untersuchungen zum Nachweis der neoplastischen Infiltration des präepi- und paraglottischen Raums, der Subglottis und des Knorpels. Die Spezifität ist jedoch mit beiden Methoden weniger hoch als zunächst erwartet, wodurch eine Tendenz zum Überschätzen der Tumorausbreitung resultiert. Neuere Untersuchungen haben jedoch gezeigt, dass die Spezifität der MRT mittels Anwendung neuer diagnostischer Kriterien signifikant verbessert werden kann, da eine Unterscheidung zwischen Tumor und peritumoraler Entzündung in vielen Fällen möglich ist. Der sehr hohe negative Vorhersagewert der beiden Schnittbildverfahren ist aus klinischer Sicht wichtig, da er es ermöglicht, die neoplastische Knorpelinfiltration auszuschließen. Beide Methoden verbessern signifikant die prätherapeutische Stagingtreffsicherheit, wenn sie zusätzlich zur Endoskopie eingesetzt werden. Bei submukösen Tumoren liefern sowohl CT als auch MRT wertvolle Hinweise auf eine mögliche Ätiologie, auf das Ausmaß des submukösen Wachstums und die geeignete Biopsiestelle. Sie spielen auch eine wichtige Rolle bei der Diagnose von Laryngozelen, der Abklärung von N.-laryngeus-recurrens-Paresen und Larynxfrakture

Multiple myeloma presenting with external ear canal mass

The manifestations of multiple myeloma are protean and related to bony osteolytic lesions, and to medullar and renal insufficiency. We report a patient who presented with otalgia as the inaugural symptom of multiple myeloma. Local irradiation combined with systemic chemotherapy led to the disappearance of the temporal bone mass and the accompanying symptoms. To date, 24 months after the diagnosis, the patient is still in remission. The literature on otological involvement in multiple myeloma is reviewed. Symptoms are non-specific and include hearing loss, tinnitus, dizziness, facial paralysis, and otalgia. The diagnosis of multiple myeloma should be considered in the presence of a temporal bone mas

Combined concomitant boost radiotherapy and chemotherapy in stage III-IV head and neck carcinomas: A comparison of toxicity and treatment results with those observed after radiotherapy alone

Background Alteration of radiation therapy (RT) fractionation and the combination of chemotherapy (CT) with RT represent two predominant fields of current research in the treatment of head and neck carcinomas. To assess the potential integration of these two fields, a retrospective comparison of toxicity and treatment outcome was carried out in stage III-IV patients treated with a concomitant boost RT schedule with or without CT. Patients and methods Fifty-two patients were treated by RT alone and 35 by RT and CT. In the RT group, there were significantly fewer T3-4 tumors (56% vs. 88%, P=0.002) and higher proportion of planned neck dissections (35% vs. 14%, P=0.047). The planned total dose was 69.9 Gy delivered over 5.5 weeks. In 10 cases CT was given before RT and in 25 concomitantly with RT, either alone or with neoadjuvant and/or adjuvant CT. All patients but two had cisplatin-based (CDDP, 100 mg/m2) CT, associated in 28 patients with 5-fluorouracil (5-FU, 1000 mg/m2/24 h × 5). The median follow-up for the surviving patients was 21 and 31 months for the RT and RT-CT groups respectively. Results Grade 3-4 acute toxicity (RTOG) was observed in 73% and 86% of patients, and grade 3 dysphagia in 31% and 57% (P=0.02) respectively in the RT and RT-CT groups. The rates of grade 3-4 late complications were similar in the two groups (5% vs. 12%). At three years, actuarial loco-regional control (LRC) was 57% and 66% (P%0.66) and overall survival was 56% and 47% (P=0.99) in the RT and RT-CT groups respectively. Conclusion While acute toxicity was higher compared with RT alone, this accelerated RT schedule was feasible in association with 5-FU/CDDP, even administered concomitantly. Despite the significant proportion of more advanced disease in the RT-CT group, LRC was similar to that obtained by RT alone. Combinations of concomitant boost RT and chemotherapy merit further investigation in prospective trial

Comparison of HTK-Custodiol and St-Thomas solution as cardiac preservation solutions on early and midterm outcomes following heart transplantation.

The choice of the cardiac preservation solution for myocardial protection at time of heart procurement remains controversial and uncertainties persist regarding its effect on the early and midterm heart transplantation (HTx) outcomes. We retrospectively compared our adult HTx performed with 2 different solutions, in terms of hospital mortality, mid-term survival, inotropic score, primary graft dysfunction and rejection score. From January 2009 to December 2020, 154 consecutive HTx of adult patients, followed up in pre- and post-transplantation by 2 different tertiary centres, were performed at the University Hospital of Lausanne, Switzerland. From 2009 to 2015, the cardiac preservation solution used was exclusively St-Thomas, whereafter an institutional decision was made to use HTK-Custodiol only. Patients were classified in 2 groups accordingly. There were 75 patients in the St-Thomas group and 79 patients in the HTK-Custodiol group. The 2 groups were comparable in terms of preoperative and intraoperative characteristics. Postoperatively, compared to the St-Thomas group, the Custodiol group patients showed significantly lower inotropic scores [median (interquartile range): 35.7 (17.5-60.2) vs 71.8 (31.8-127), P < 0.001], rejection scores [0.08 (0.0-0.25) vs 0.14 (0.05-0.5), P = 0.036] and 30-day mortality rate (2.5% vs 14.7%, P = 0.007) even after adjusting for potential confounders. Microscopic analysis of the endomyocardial biopsies also showed less specific histological features of subendothelial ischaemia (3.8% vs 17.3%, P = 0.006). There was no difference in primary graft dysfunction requiring postoperative extracorporeal membrane oxygenation. The use of HTK-Custodiol solution significantly improved midterm survival (Custodiol versus St-Thomas: hazard ratio = 0.20, 95% confidence interval: 0.069-0.60, P = 0.004). This retrospective study comparing St-Thomas solution and HTK-Custodiol as myocardial protection during heart procurement showed that Custodiol improves outcomes after HTx, including postoperative inotropic score, rejection score, 30-day mortality and midterm survival

Tracheostomy reveals a rare aberrant right subclavian artery; a case report

BACKGROUND: Anomalies of vascular anatomy in the neck are well recognised. We present a case of a very rare aberrant artery discovered during tracheostomy. CASE PRESENTATION: Elective tracheostomy was performed in theatre for an elderly gentleman on long-term ventilation. Pre-operative examination of the neck revealed no obvious abnormality. During surgery, a large vessel was revealed overlying the tracheal fourth ring. This was found to be an anomalous right subclavian artery. The procedure was completed without complication. CONCLUSIONS: The vessel abnormality described has not been previously documented in this context. It illustrates the importance of thorough pre-operative assessment of the neck and a sound knowledge of the potential for vascular abnormalities. The increasing prevalence of percutaneous dilatational tracheostomy techniques makes this lesson increasingly relevant

Neoadjuvant chemotherapy in the setting of locally advanced olfactory neuroblastoma with intracranial extension

Olfactory neuroblastoma (esthesioneuroblastoma) is a rare malignant tumor of neuroectodermal origin. With only about 1,000 cases reported, there are no clear guidelines regarding management of this disease. Intracranial extension and orbital involvement have been shown to be independent risk factors associated with poorer outcomes. We hereby report a case of a 46-year old male presented with an 8-month history of progressive nasal obstruction and intermittent right-sided epistaxis associated with anosmia and increased pressure sensation in and around the right eye. Further evaluation revealed a large enhancing heterogeneous cystic and solid mass in the right nasal cavity measuring 5.0×5.3×4.6 cm with extension superiorly into the anterior cranial fossa and frontal lobes, ethmoid and sphenoid sinuses. A biopsy of this mass confirmed high grade olfactory neuroblastoma. Because of the intra-cranial extension, a decision was made to start neoadjuvant chemotherapy with cisplatin and etoposide. The patient had very good response to this treatment on a repeat imaging study and went on to have resection of this mass. Post-operatively, he received radiation therapy to the tumor bed and 2 more cycles of chemotherapy. He has been followed now for more than 8 months with no evidence of disease recurrence

Acute upper airway failure and mediastinal emphysema following a wire-guided percutaneous cricothyrotomy in a patient with severe maxillofacial trauma

Contains fulltext : 69538.pdf (publisher's version ) (Open Access)BACKGROUND: In the presence of severe maxillofacial trauma, management of the airway is important because this condition poses a significant threat to airway patency. That securing the airway is not always straightforward is described and illustrated in this paper. CASE: We present the case of a 23-year-old patient who sustained severe maxillofacial injury for which airway control was necessary. A wire-guided percutaneous dilation cricothyrotomy was performed, which was most probably the cause of an acute loss of airway patency. The literature regarding the role of percutaneous techniques in an elective and emergency setting is reviewed

Motility-related protein-1 (MRP-1/CD9) expression can predict disease-free survival in patients with squamous cell carcinoma of the head and neck

CD9 is a transmembrane protein that has been implicated in cell adhesion, motility and proliferation, and numerous studies have demonstrated the prognostic value of its expression in different solid tumours. The purpose of this study is to determine the predictive value of CD9 in squamous cell carcinoma (SCC) of the head and neck. A total of 153 cases were examined for CD9 expression using immunohistochemistry applied on formalin-fixed, paraffin-embedded tissue. Cases were stratified in two categories depending on CD9 expression, as positive (>/=50% positive cells) or reduced (<50%). In all, 108 cases were positive for CD9 (85 cases with membranous, and 23 with both membranous and cytoplasmic staining) and 45 reduced expression. Reduced CD9 expression was significantly associated with high grade (P=0.0007) and lower disease-free survival (DFS) (P=0.017). The latter retained its significance in the multivariate analysis. When the 23 cases with both membranous and cytoplasmic patterns were studied as a separate subgroup, there were significant associations between CD9 expression and tumour grade (P=0.025) (95% CI 11-68), tumour stage (P=0.08) (95% CI 3.5-86) and the occurrence of any failure (P=0.083) (95% CI -1.7-57). Immunohistochemical CD9 expression proved to be an independent prognostic factor in SCC of the head and neck, and it may detect patients at a high risk of recurrence. In addition, the cytoplasmic pattern seems to have an even more significant value. However, this finding is limited to the small number of cases with this pattern