18F-Fluorodeoxyglucose Uptake Level-Based Lymph Node Staging in Oropharyngeal Squamous Cell Cancer - Role of Molecular Marker Expression on Diagnostic Outcome

Background: A prospective study was performed to assess standard uptake value (SUV)-level based 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) lymph node staging in 33 patients with oropharyngeal squamous cell cancer (OSCC) out of a total of 99 patients with head-and-neck squamous cell cancer (HNSCC) and the role of nodal molecular marker expression in diagnostic outcome prediction. Methods: Preoperative nodal PET/CT staging in 123 lymph nodes was correlated with postoperative lymph node histology, which served as gold standard. Tissue samples were prepared for immunohistochemistry of the excised lymph nodes. Results: The negative and positive predictive values (NPV and PPV) of PET for correct lymph node assessment were 100% and 93%, respectively. There was a significant association between SUVmax and lymph node histology (p < 0.0001) and a significant linear correlation between SUVmax and nodal size (Pearson’s correlation coefficient r = 0.61336, p < 0.0001). The molecular marker E-Cadherin was significantly overexpressed in lymph node metastases (p < 0.0001). Benign lymph nodes showed significant 2-fold Bcl2 overexpression (p < 0.0001). However, the molecular marker expression profiles were inhomogeneous and did not allow valuable diagnostic outcome prediction. Conclusions: SUV level-based 18F-FDG-PET/CT lymph node assessment in OSCC still has to be considered as the most established and reliable staging tool. Lymph node molecular marker expression profiles need to be investigated further as they currently do not sufficiently contribute to therapy decision-making

Mutation analysis of "Endoglin" and "Activin receptor-like kinase" genes in German patients with hereditary hemorrhagic telangiectasia and the value of rapid genotyping using an allele-specific PCR-technique

<p>Abstract</p> <p>Background</p> <p>Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is an autosomal dominant disorder which is clinically characterised by recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. Genetic linkage studies identified two genes primarily related to HHT: endoglin (<it>ENG</it>) on chromosome 9q33-34 and activin receptor-like kinase1 (<it>ACVRL1</it>) on chromosome 12q13. We have screened a total of 41 unselected German patients with the suspected diagnosis of HHT. Mutation analysis for the <it>ENG </it>and <it>ACVRL1 </it>genes in all patients was performed by PCR amplification. Sequences were then compared to the HHT database <url>http://www.hhtmutation.org</url> sequences of the <it>ENG </it>mRNA (accession no. BC014271.2) and the <it>ACVRL1 </it>mRNA (accession no. NM000020.1).</p> <p>Results</p> <p>We identified 15 different mutations in 18 cases by direct sequencing. Among these mutations, one novel <it>ENG </it>mutation could be detected which has not yet been described in the literature before. The genotype-phenotype correlation was consistent with a higher frequency of pulmonary arteriovenous malformations in patients with <it>ENG </it>mutations than in patients with <it>ACVRL1 </it>mutations in our collective.</p> <p>Conclusion</p> <p>For rapid genotyping of mutations and SNPs (single nucleotide polymorphisms) in <it>ENG </it>and <it>ACVRL1</it>, allele-specific PCR methods with sequence-specific primers (PCR-SSP) were established and their value analysed.</p

Plastische Rekonstruktion einfacher und komplexer Nasendefekte

Zusammenfassung Wahrend einfache Defekte auch durch freie Hauttransplantate oder lokale Lappenplastiken rekonstruiert werden konnen, stellen komplexe dreischichtige Defekte eine Herausforderung fur den rekonstruktiv tatigen Chirurgen dar. Diese bezieht sich in erster Linie auf eine suffiziente Wiederherstellung der inneren Nasenauskleidung, ohne die physiologischen Funktionen der Nasenschleimhaut zu kompromittieren. Die Autoren gehen auf verschiedene Rekonstruktionstechniken zur Wiederherstellung der inneren Nasenauskleidung ein. Eine besondere Bedeutung kommt hier dem epithelialen Kipplappen und dem kurzlich erst beschriebenen pralaminierten Stirnhautlappen bei (sub)totalen Nasendefekten zu. Beide haben sich in der Wiederherstellung der inneren Nasenauskleidung als sehr wertvolle und schleimhautschonende Alternativen zu herkommlichen intranasalen Schleimhautlappen bewahrt

Interdisciplinary Management of Head and Neck Vascular Anomalies: Clinical Presentation, Diagnostic Findings and Minimalinvasive Therapies

Objectives: Vascular anomalies are included in the 30 000 rare diseases worldwide affecting less than 5/10 000 people. Depending on their morphology and biological properties, they can cause varied disorders with organ involvement. Almost 60% of vascular anomalies have a predilection for the head and neck region in children. Clinical and scientific effort to establish interdisciplinary management concepts for vascular anomalies is increasing worldwide. Methods: Especially in the head and neck region, clinical impairment and organ dysfunction is associated with cosmetic issues that may represent a physical and psychological issue for the patient. Correct diagnosis, based on clinical presentation and symptoms, is a prerequisite for appropriate therapy, ranging from conservative management to a spectrum of minimally invasive treatment options. We searched PubMed for German and English language published data until December 2016 with focus on clinical studies, review articles and case reports on vascular anomalies with a focus on the head and neck region. Results: The last ISSVA update in 2014 has contributed to a better understanding of vascular anomalies, classifying them in vascular tumors and vascular malformations. The predominant representatives of vascular tumors are congenital and infantile hemangiomas. Infantile hemangiomas have the ability of spontaneous regression in more than 80%. Patients with symptomatic growing hemangiomas with ulcerations, bleeding complications and restriction of hearing, swallowing disorder, impairment of vision, or cosmetic dysfigurement require treatment. Therapies include oral propanolol, transcatheter embolization and surgery. Vascular malformations tend to progress with patientsÌ age and are subdivided in slow flow and fast flow lesions. Symptomatic slow flow lesions, e.g. venous and lymphatic malformations, benefit from percutaneous sclerotherapy. Fast flow lesions, as arteriovenous malformations, are rare but undoubtedly therapeutically the most challenging vascular anomaly. Depending on location and size, they may require multiple transcatheter embolization procedures for successful occlusion of the AVM. Conclusions: This review provides knowledge on the current ISSVA classification of vascular anomalies, their clinical presentation, diagnostic evaluation and minimally invasive therapy options to encourage the establishment of a comprehensive interdisciplinary management for head and neck vascular anomalies. Keywords: Vascular Anomalies, Head and Neck, Hemangioma, Venous Malformatio

Sulindac sulfone modulates β-Catenin in human cholesteatoma cell culture

Background. External auditory canal cholesteatoma (EACC) is a chronic inflammation of the bony ear meatus. Its etiology is not clearly understood. Other than surgical intervention, conservative methods are investigated for different cholesteatomas. Inducing apoptosis seems to be an appropriate strategy. Sulindac sulfone is a new class of targeted and pro-apoptotic drugs. It provokes apoptosis by inducing phosphorylation of beta-catenin, which is a multifunctional protein in the cell-cell adhesion complex. Methods. EACC-cell cultures were incubated with different concentrations of sulindac sulfone (400 and 800 mu mol). After 16, 24, and 48 h, beta-catenin concentrations were determined by ELISA, Western blot, and immunohistochemical analysis. Results. After 48 h incubation with 400 mu mol sulindac sulfone, the average level of beta-catenin showed a decrease of 46% (0.004337 mu g/mL) from those determined at 16 h with the same concentration of sulindac sulfone. At 800 mu mol sulindac sulfone, the treated cell culture showed a reduction of 66.2% (0.003443 mu g/mL). Comparing total protein content and the fraction of beta-catenin at different points in time, the concentration of beta-catenin decreased in both EACC cell cultures, 400 mu mol (minus 63%) and 800 mu mol (minus 81%). Conclusions. The results presented in this paper are the first to demonstrate the chemopreventive effects of the agent sulindac sulfone on cholesteatomas. The greatest decrease of beta-catenin was observed between 16 and 24 h incubation. The inhibitory effect of sulindac sulfone as a local treatment seems to be a useful additional tool for nonsurgical approach to the therapy of EACCs. (C) 2007 IMSS. Published by Elsevier Inc