Image-Adapted brachytherapy (IABT) is a modern interdisciplinary development of classic radiation therapy, which allows the application of a high radiation dose while avoiding severe adverse events, thereby improving the prognosis of our patients. Indications in head and neck squamous cell carcinoma (HNSCC) include tumours of the floor of mouth, the face, the paranasal sinuses, the naso- and oropharynx, recurrent cancer and incomplete resections due to close vicinity of the tumor to important structures. The application type can be classified as curative, adjuvant, perioperative as a boost with or without external beam radiation (EBRT) or as a palliative treatment. The published results encourage the integration of IABT as part of the therapy of HNSCC, thereby improving the prognosis and quality of life of our patients.

Hintergrund: Methode und Patienten: Ergebnisse: Schlussfolgerung: Brachytherapy in Combination with Function-Preserving Surgery of Cancer of the Paranasal Sinus Backgrund: Methods and Patients: Results: Conclusions:

Die Gestalt der Lippen geht auf die Herkunft aus verschiedenen Gesichtswülsten zurück (4. Embryonalwoche)

The human tongue is particularly resistant to bacterial infections although the mouth is continuously exposed to a complex and abundant ensemble of microbes, such as the common intestinal bacterium Escherichia coli. We show that lingual epithelia produce and release, as a primary E. coli-killing compound, the S100 protein psoriasin. No significant reduction in psoriasin release could be achieved through repeated rinsing of the epithelial surface of the tongue. Psoriasin is produced in the upper layers of the lingual epithelia but is lacking in the most superficial and basal cells. It displays a gradient pattern of expression with decreasing expression from the anterior one-third to the posterior portion of the tongue. Thus, psoriasin may be the key to the resistance of the human tongue toward E. coli.

BACKGROUNDHead and neck squamous cell carcinomas (HNSCC) are aggressively growing tumors with only marginal improvement in outcome despite ongoing developments in treatment protocols. This problem has been associated with a lack of therapy individualization on tumor biological properties.MATERIALS AND METHODSmRNA expression profiles of HNSCC and normal epithelial cells were compared in order to identify genes associated with cancer formation. Differential display was used to trace gene fragments showing differential expression in HNSCC cells, which were than isolated, re-amplified, cloned and sequenced.RESULTSA 131-bp-long fragment was identified to be overexpressed in HNSCC cells that revealed a 99.3% homology with p68 mRNA. The differential expression was confirmed by Northern hybridization.CONCLUSIONThe data presented suggest an involvement of p68 in the process of malignant transformation or progression of HNSCC.

Das Prinzip des Wächterlymphknotens, der als erste Filterstation eines soliden Tumors entscheidende prognostische Bedeutung besitzt, wird bei Patienten mit malignem Melanom und Mammakarzinom schon heute erfolgreich an großen Patientenzahlen eingesetzt. Ziel ist es, bei nachgewiesener Tumorfreiheit dieses so genannten Sentinel Lymph Node (SLN) auf eine weitere Lymphknotenentfernung zu verzichten und damit die postoperative Morbidität dieses häufig großen Eingriffs zu reduzieren. In ersten klinischen Studien wurde das SLN-Prinzip auch bei Patienten mit Kopf-Hals-Tumoren angewandt, wobei die anatomische Lage des Primärtumors und der am Hals sehr dichte, teilweise bilaterale Lymphabfluss oftmals hohe methodische Probleme aufwerfen können. Neben der geschulten Handhabung der intraoperativen Gammasonde sind insbesondere das genaue präoperative Staging zur Festlegung des N0-Status und die gewissenhafte histopathologische Aufarbeitung des oder der betreffenden Lymphknoten von enormer Bedeutung für die Sensitivität der Methode. Die vorliegende Arbeit fasst die bisher publizierten Daten zur SLN-Methode bei Patienten mit Kopf-Hals-Tumoren zusammen, beschreibt spezielle methodische Aspekte der SLN-Markierung und Szintigraphie und bewertet die gegenwärtige Bedeutung des Verfahrens in der klinischen Routinediagnostik.

Background, Matrix metalloproteinases (MMPs) play an important role in tumor invasiveness. This study investigates the expression status of MMPs and tissue inhibitors of metalloproteinases (TIMPs) in head and neck squamous cell carcinomas (HNSCC).Methods. Of 48 laryngeal squamous cell carcinoma (LSCC) biopsies and 10 HNSCC cell lines, mRNA was isolated, reversely transcribed, and subjected to polymerase chain reaction (PCR) amplifying MMP-1, MMP-2, MMP-9, MMP-10, TIMP-1, and TIMP-2. Silver nitrate-stained gel electrophoresis demonstrated MMP and TIMP expression status. Exemplary immunohistochemistry and zymography confirmed translation and enzyme activity.Results. Densitometric analysis revealed MMP-2 expression and lymph node metastases to be positively and TIMP-1 and TIMP-2 to be negatively correlated with lymph node metastases. TIMP-2 expression and tumor size were negatively correlated. MMP-1, MMP-9, and MMP-10 expression were not correlated to metastasis formation or tumor size.Conclusions. Our results suggest that MMP-2 expression enhances, whereas TIMP-1 and TIMP-2 both suppress, cancer spread in LSCC. (c) 2005 Wiley Periodicals, Inc.

Background: Nasal polyposis is mostly associated with eosinophilia of mucosal tissue. This points to the implication of CC chemokines in nasal eosinophilia. Recently the CC chemokine eotaxin-2 (CCL24) was identified. This study was initiated to localize the cellular source, analyze expression of mRNA, and quantify protein synthesis of CCL24. Methods: Specimens of nasal inferior turbinates from controls and polypous tissue from patients suffering from chronic polypous sinusitis were collected. Furthermore, fibroblasts and epithelial cells were cultured. CCL24 protein was analyzed by immunohistochemistry and ELISA, expression of mRNA by SQ-RT-PCR. Results: CCL24 was observed in endothelial and epithelial cells. Specimens from patients expressed significantly (>2fold) more CCL24 mRNA than controls. Fibroblasts and unstimulated cells did not express CCL24 mRNA. Upon stimulation with TNF-α, INF-γ, IL-4, or costimulation with TNF-α and INF-γ CCL24 mRNA was significantly enhanced (3.2–19.6%). In controls, fibroblast, and unstimulated cells CCL24 protein was below detection limit. Most polyps comprised significant amounts of CCL24 (mean 0.24 ng/mg). TNF-α, INF-γ or IL-4 induced CCL24 protein (0.1–0.3 ng/ml) in epithelial cells. Costimulation with TNF-α and IL-4 (0.1–30 and 1–30 ng/ml, respectively) synergistically induced synthesis of CCL24 protein (0.18–0.31 ng/ml). Conclusion: In nasal polyps endothelial and epithelial cells are obviously the main source of CCL24, which was shown for transcription (mRNA) and production (protein) levels and was associated with diseases. Results gave evidence of CLL24- directed migration of cells from inside (the bloodstream) to the epithelial side (mucosa) in eosinophilic inflammatory diseases, e.g. nasal polyposis.

Die vorliegende Kasuistik beschreibt den Fall eines 67-jährigen Patienten mit plötzlicher Atemwegsobstruktion durch spontane Weichteileinblutungen in die Zunge, Mundhöhle und den Hypopharynx ohne anamnestisch bekannte hämorrhagische Diathese. Bei Erstkonsultation bestanden zusätzlich zu einem Globusgefühl mit Dysphagie eine kloßige Sprache und eingeschränkte Mundöffnung. Die Computertomographie zeigte weichteildichte Raumforderungen von Mundboden, Zungengrund und rechter Pharynxseitenwand. Am folgenden Tag musste der Patient wegen plötzlicher respiratorischer Insuffizienz aufgrund einer kompletten Verlegung der Atemwege bei nicht durchführbarer Intubation koniotomiert werden. Die Gerinnungsdiagnostik zeigte eine herabgesetzte Faktor-VIII-Aktivität durch den Nachweis von gegen Faktor VIII gerichteten Autoantikörpern. Anhand dieser Kasuistik und einer vergleichenden Übersicht über die Literatur stellen wir die Diagnostik und Therapie der erworbenen Hämophilie A dar.

BACKGROUND:Characteristic infiltrates of eosinophils are a hallmark of nasal polyps (NPs). Several studies suggest that members of the CC chemokine family may be involved in this process. RANTES (regulated on activation, normal t-cell-expressed and secreted) is a member of the CC chemokine family with chemotactic activity on mainly eosinophils and T lymphocytes. Thus, RANTES is an interesting target for the recruitment of eosinophils and T lymphocytes into the nose. The degree of the tissue eosinophilia has been reported to correlate with the severeness of the symptomatology of the disease and the extension on the lower respiratory tract, as well as with the probability of the recurrence of NPs. Therefore, we hypothesized that high numbers of eosinophils correlate with high levels of RANTES and that associated atopic diseases modify this correlation.METHODS:Total RNA was extracted from NP homogenates, reverse transcribed and RANTES mRNA expression analyzed using semiquantitative reverse transcription polymerase chain reaction and Northern blot analysis. Histological studies divided NPs in an eosinophilic and low eosinophilic group. Additionally, RANTES protein concentration was measured in homogenates by a RANTES-specific enzyme-linked immunosorbent assay.RESULTS:This study has clearly shown that RANTES is expressed and secreted in NPs. The group with a high tissue eosinophilia had a significant higher RANTES gene expression and protein production than NPs without tissue eosinophilia. The isolated coincidence of acetylsalicyl acid intolerance with chronic hyperplastic sinusitis/NP additionally increased significantly the RANTES amounts in NPs.CONCLUSION:Increased RANTES leads to increased tissue eosinophilia. Associated acetylsalicylic acid intolerance seems to enhance the amount of RANTES in NPs and might explain in part the more severe clinical course in those patients. Thus, RANTES appears to play an important role in mobilization of eosinophils into the local inflamed tissue.

Infections of healthy skin or mucous membranes are rare despite constant exposure to microbial colonization. Nonspecific and specific defense mechanisms correspond in the nose; the mucocillary clearance provides very effective mechanical cleaning. If this protection is sufficient, the nasal epithelium comes ionto close contact with microorganisms. This triggers the recently discovered production of the body's own specific antimicrobial peptides (AP). It seems that it is difficult for microorganisms to form enzyme-induced resistance to AP. This makes AP highly interesting for the development of new antibotics. The observation that antimicrobial activity can be induced has also led to the hypothesis taht natural substances may possibly stimulate endogenous AP production. If this line of defense also fails, the inflammatory cells migrate from the blood into the tissue and , with their capacity for phagocytosis, the enzymatic attack on bacteria can cause a cellular inflammatory reaction in the nasal mucous membrane.