Pyoderma gangrenosum in the head and neck.
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Aged↗
Biomedical subjects
Claus Wittekindt
Publications and source records attributed to Claus Wittekindt.
Immunohistochemistry of whole-organ sections of advanced human laryngeal cancer.
Whole-mount sections have been in the interest of laryngologists for long time. The aim of this study was to demonstrate the technical aspects of processing horizontal whole-mount sections of advanced laryngeal cancer specimens after total laryngectomy. Those sections may provide new insights in the biology of laryngeal cancer. Six excised human larynges were block-embedded in paraffine. Serial sections were obtained as thin as 9 mum. Sections were stained by Giemsa and standard immunohistochemistry protocols with commercial antibodies against Cytokeratine5/6, Ki-67, Topoisomerase IIalpha, and p53. Four high-power fields were selected randomly in each section of a surface grid and the percentage of positive tumor cells was noted for each antibody in the respective field. Morphometric surface maps of protein expression were generated for each parameter. The tissues remained intact without major artifacts. Specific characteristics of the tumors were identified after evaluation of the whole-mount sections. Staining of cytokeratine was homogenous, whereas nuclear markers showed a distinct heterogeneity in the respective staining patterns. By analyzation of color-coded fusion images the spatial expression of the respective antibodies could be visualized.
Adult↗
Successful OK-432 therapy for a supraclavicular lymphocele: report of a case.
Surgery is considered the gold standard in the treatment of lymphoceles, however this is not feasible for all cases. We report the successful treatment of a supraclavicular lymphocele by intralesional application of the sclerosing agent OK-432. After a total of three intralesional injections of OK-432, the cyst had disappeared completely and the patient was free of symptoms. Thus, intralesional application of OK-432 is considered a highly effective treatment for cystic masses such as lymphoceles.
Antineoplastic Agents↗
Lymphatic malformations of the head and neck: introduction of a disease score for children, Cologne Disease Score (CDS).
OBJECTIVE: A clinical staging system for children with lymphatic malformations that would allow for a standardized comparison of disease and treatment outcomes. METHODS: We developed an examination sheet for the determination of a disease score ranging from 0 (worst) points to 10 (best) points, Cologne Disease Score (CDS). Disfigurement, dysphagia, dysphonia, dyspnea and an observer statement towards progression were contributing to CDS. Each parameter yielded two, one or zero points. Two points were given when no limitation was seen in the patient concerning the respective item. One point was given at mild limitation and zero points were given when considerable limitation in the respective item could be observed. We evaluated 26 patients with lymphatic malformations of the head and neck retrospectively by completing one examination sheet for each patient-visit. RESULTS: Four patients had an initial CDS value of three or less points (severe disease-group). After therapy the mean value of their score increased only slightly to 3.9+/-2.6 points. Six patients had an initial CDS value of four, five or six points (advanced disease-group). After treatment their mean score value increased dramatically to 9.0+/-1.5 points (P<0.001). Sixteen patients initially had seven points or higher (moderate disease-group), they had 9.8+/-0.4 points after treatment. CONCLUSIONS: The evaluation of the CDS was easy and expeditious. The score itself was a good predictor in view of the outcome. This new disease score for paediatric patients might be appropriate to evaluate therapeutic trials in paediatric patients.
Adolescent↗
Do homeopathic drugs affect microcirculation in vertigo?
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Clinical Trials as Topic↗
Radiology quiz case 1: Intracranial schwannoma originating from the greater petrosal nerve.
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Cranial Fossa, Middle↗
Impact of lateral parotidectomy for benign tumors on quality of life.
CONCLUSION: This study supports the use of lateral parotidectomy as a safe and standardized type of surgery for benign parotid gland disease. OBJECTIVE: To assess quality of life in patients with benign salivary gland tumors who underwent lateral parotidectomy. PATIENTS AND METHODS: Fifty-one patients suffering from benign parotid gland disease were included in this prospective study. Using the EORTC QLQ-C30 and EORTC-QLQ-H&N35 questionnaire, surgery-affected changes in quality of life were assessed in 34 patients who completed this survey. RESULTS: Overall results show no alterations in quality of life 1 year after lateral parotidectomy.
Adenolymphoma↗
High risk for bilateral Warthin tumor in heavy smokers--review of 185 cases.
CONCLUSIONS: We identified smoking as a significant risk factor for multilocular Warthin tumor development. Therefore, we recommend taking history of smoking into account when making the decisions for surgical strategy. OBJECTIVES: Warthin tumor is a common benign neoplasm of the parotid gland. Risk factors for multilocular development have not been defined. PATIENTS AND METHODS: A total of 185 consecutive patients treated for Warthin tumor were included. Charts were reviewed for symptoms, risk factors, and diagnostic and surgical procedures. Patients were followed for facial function and recurrence. Risk factors were evaluated. RESULTS: Overall, in 203 parotid operations, a lateral parotidectomy (77%) was performed in most cases; 94% were primary surgery and 6% were revision surgery. In 89% of patients swelling was the only symptom. Bilateral Warthin tumor was seen in 17% of patients. Of these cases synchronous and metachronous bilateral tumors were observed in 61% and 39%, respectively. The median time period for second contralateral tumor development was 7 years. Postoperative transient facial dysfunction was observed in 31%, which recovered within 3 months in all cases. Evaluation of risk factors revealed that 89% of the subjects were smokers and 66% were heavy smokers. The risk for bilateral Warthin tumors correlated significantly with the amount of nicotine intake (p=0.003).
Adenolymphoma↗
Parotidectomy for benign parotid disease at a university teaching hospital: outcome of 963 operations.
OBJECTIVE/HYPOTHESIS: The objective of this study was to analyze the perioperative and long-term complications after standardized lateral and total parotidectomy for benign parotid tumors and chronic parotitis with special regard on the training skill of the surgeons at a university teaching center. All teaching operations were performed under strict microscopic control and supervision of experienced surgeons. STUDY DESIGN: The authors conducted a retrospective unicentric study in a tertiary university center. METHODS: Medical records of 963 lateral and total parotidectomies treated from 1986 to 2004 were analyzed with regard to perioperative and long-term complications. The surgeons' expertise to perform a parotidectomy was classified as beginner (0-20 parotidectomies performed), advanced (21-50), experienced (51-100), or highly experienced (>100). RESULTS: Eighty-five percent of the cases were primary operations (85%) and 15% revision operations. A lateral parotidectomy was necessary in 61% and total parotidectomy in 39%. The mean operation time was 192 minutes. The incidence of transient facial nerve dysfunction was 25%, and 6% for permanent weakness, respectively. Treatment for Frey's syndrome was performed in 5%. First recurrence for pleomorphic adenoma was observed in 2% and for Warthin's tumor in 3%. Significantly more complications were seen after total parotidectomy and in revision cases. Beginners and advanced surgeons (operated 41% of the cases) needed a longer operation time than experienced and highly experienced surgeon (59% of the cases). The surgeon's expertise had no influence on the incidence of complications. CONCLUSIONS: Standardized education in lateral and total parotidectomy for treatment of benign parotid disease under precise microscopic control is safe, demonstrates good results, and has low perioperative and long-term morbidity.
Clinical Competence↗
Botulinum toxin A for neuropathic pain after neck dissection: a dose-finding study.
OBJECTIVES: Botulinum toxin type A (BtxA) has been reported to be feasible in chronic neuropathic pain after neck dissection. The impact of the dose on the outcome has not been investigated yet. STUDY DESIGN: Twenty-three patients with neuropathic pain after neck dissection were selected for an open and prospective phase II trial. METHODS: In the low-dose group (n=13), a concentration of 10 mouse units (MU)/0.1 mL saline and in the high-dose-group (n=10), a concentration of 20 MU/0.1 mL saline were injected subcutaneously. Pain and quality of life were assessed at day 0 and day 28, respectively, by visual analog scales (VAS) and European Organization for Research and Treatment of Cancer (EORTC) quality-of-life core and EORTC quality-of-life head and neck module questionnaires. RESULTS: Patients in the low-dose group showed a significant pain reduction (VAS) from 4.3 at day 0 to 3.0 at day 28 (P<.05). The mean pain VAS values in the high-dose group did not improve significantly. No serious adverse events were observed. There were trends toward improvement in quality of life in the low-dose group. CONCLUSIONS: BtxA in a low concentration seems to be a useful therapeutic option in chronic neuropathic pain of the neck and shoulder after neck dissection.
Botulinum Toxins, Type A↗
Expression of p16 protein is associated with human papillomavirus status in tonsillar carcinomas and has implications on survival.
Our recent analysis of papillomavirus (HPV) DNA in different malignant head and neck tumors revealed that HPV infections occurred most frequently in tonsillar carcinomas (58%) and that 84% of positive cases contained the highly oncogenic HPV type 16. We could also present data in favor of the hypothesis that in view of their clinical behavior and the involved risk factors HPV-positive and HPV-negative tonsillar carcinomas may represent two separate tumor entities. Looking for a surrogate marker, which in further epidemiological studies could replace the laborious and expensive HPV detection/typing we analyzed p16 protein expression in 34 tonsillar carcinomas for their correlation with HPV status. p16 is an inhibitor of cyclin-dependent kinases 4 and 6 which activate the negative cell cycle regulator protein pRB which in turn downregulates p16 expression. It could be shown that in neoplastic cells of the cervix uteri E7 protein of the high-risk HPVs can interfere with this regulatory circuit by its virtue to inactivate pRB and thus lead to the overexpession of p16. We found 53% of the tested tonsillar carcinomas to be HPV positive. 56% of all tumors tested were immunohistochemically positive for the p16 protein. In 16 of 18 of the HPV-positive carcinomas diffuse p16 expression was observed. In contrast, only 1 of the HPV-negative carcinomas showed focal p16 staining (p < 0.001). Clinical outcome analysis revealed a significant correlation of p16 expression with increased disease-free survival (p = 0.02). These data indicate that p16 is a technically simple immunohistological marker, applicable for routine pathological histology, and its prognostic value for survival is fully equivalent to HPV DNA detection.
Biomarkers, Tumor↗
Recurrent pleomorphic adenoma of the parotid gland: a prospective histopathological and immunohistochemical study.
OBJECTIVES/HYPOTHESIS: Histopathological characteristics and proliferation indices of recurrent pleomorphic adenoma were described in a series of 31 patients who were referred to the authors' clinic for revision surgery. STUDY DESIGN: Prospective series of 31 patients. METHODS: Serial sections of surgical specimen using the whole-organ sectioning technique were carried out for light microscopic examination after total parotidectomy and periparotid fat resection. The nodules were examined with special reference to localization, amount, size, histological subtypes, capsular alterations, and the amount of nodule spilling. Expression of proliferation markers (Ki67/MIB-1) according to the size and histological subtypes of the nodules was also investigated. RESULTS: Most recurrences were multinodular, and the number of nodules was much higher than expected, ranging from 1 to 157. The myxoid subtype was predominant. Eighty percent of the patients exhibited widely distributed nodules also lying outside the scar. These nodules contained only a thin pseudocapsule and often lacked complete encapsulation. The majority of multinodular recurrences of parotid pleomorphic adenoma consisted of small nodules (less than 1 mm in diameter). Smaller nodules showed similar or higher levels of proliferative activity than larger nodules. CONCLUSION: The extended multifocal distribution of tumor recurrences after insufficient resection of pleomorphic adenoma (most often after enucleation) can explain a high incidence of further recurrences. Therefore, a total parotidectomy including removal of surrounding fat tissue seems to be appropriate for the initial treatment of recurrent pleomorphic adenoma.
Adenoma, Pleomorphic↗
Successful adjuvant tamoxifen therapy for estrogen receptor-positive metastasizing sweat gland adenocarcinoma: need for a clinical trial?
We report on successful adjuvant tamoxifen therapy for a metastasizing sweat gland adenocarcinoma of the scalp in a 64-year-old woman. Before the antihormonal therapy, the patient had undergone repeated surgery for ipsilateral intraparotid, soft tissue, and lymph node metastases and had had disease-free intervals of less than 5 months. As the immunohistochemical analysis of the tumor tissue revealed a 100% nuclear reactivity to estrogen and progesterone receptors, we started empirical tamoxifen citrate therapy, which dramatically changed the course of the disease. The patient has been in complete remission for 3 years. This is the third report in the literature of substantial therapeutic benefit of antiestrogen therapy in metastasizing eccrine gland adenocarcinoma with positive hormone receptor immunohistochemistry. We suggest examining the hormone receptor expression in these neoplasms regularly. A prospective study should be commenced to assess the benefit of adjuvant antihormonal therapy in eccrine gland adenocarcinomas.
Antineoplastic Agents, Hormonal↗
New aspects in parotid gland surgery.
We present our results of current research on parotid gland surgery at our clinic. a) Histopathological characteristics of pleomorphic adenomas, especially of capsular alterations like thin capsule areas, capsule-free regions, satellite nodules, and pseudopodia in the different subtypes were analyzed in 100 consecutive patients. 51 pleomorphic adenomas were classified as stroma-rich type, 35 as cell-rich-type, and 14 as classical subtype. 97% of all tumors showed areas with very thin (< 20 mm) capsules. Stroma-rich tumors showed the absolute greatest regions of very thin capsules and exhibited focal absence of encapsulation in 71% of the tumors. 11% of the cell-rich and 43% of the classical subtype tumors also presented capsule-free areas. Satellite nodules and pseudopodia were present in 33% of the stroma-rich tumors, respectively 23% in cell-rich, and 21% in classical subtype tumors. Therefore, enucleation or local dissection of the pleomorphic adenoma can not be a sufficient surgical treatment of this special tumor entity. We recommend lateral or total parotidectomy as the treatment of choice. b) To ascertain the incidence of clinically apparent and occult lymph node metastases in patients with major salivary gland cancers we analyzed 160 consecutive patients that underwent parotidectomy and neck dissection. Histologically confirmed positive neck was found in 53% of all cases. The histology of the primary tumor had a significant influence on the incidence of lymph node metastasis: Highest incidence of 89% (16/18) was found in undifferentiated carcinomas, however also so-called low-risk tumors showed a rate from 22% to 47%. Of the 139 patients with clinical N0 neck 45% had occult neck metastasis. In conclusion neck dissection should be considered as an integral part of the surgical concept in major salivary gland cancer patients.
Adenoma, Pleomorphic↗
Management of bilateral arytenoid cartilage fixation versus recurrent laryngeal nerve paralysis.
Bilateral arytenoid cartilage fixation (ACF) closely resembles vocal cord immobility due to recurrent laryngeal nerve paralysis (RLNP). This study sought to determine the etiologic differences between these two entities and to derive conclusions about treatment. The charts of 218 consecutive adult patients with immobility of both vocal cords requiring surgery for airway restoration were reviewed. The results of laryngeal electromyography and laryngotracheoscopy were used to distinguish ACF from RLNP. In 186 patients (85.3%), RLNP was identified. Of these, 154 paralyses (82.8%) were caused by surgical interventions, 5 (2.7%) were caused by previous intubation, 16 (8.6%) were caused by various malignancies, and 7 (3.8%) were neurogenic. In 4 patients (2.2%), the cause remained unclear. We identified ACF in 32 patients. The etiologic factors included previous long-term intubation in 22 patients (68.8%), short-term intubation in 3 patients (9.4%), Wegener's granulomatosis in 3 patients (9.4%), rheumatoid arthritis in 2 patients (6.3%), previous laryngeal surgery in 1 patient (3.1%), and caustic ingestion in 1 patient (3.1%). Additional second-site airway stenosis was found in 10 of the RLNP patients (5.4%) and in 15 of the ACF patients (46.9%). All RLNP patients had endoscopic surgery without temporary tracheotomy. Eighteen ACF patients required open surgery, and 4 were managed endoscopically but required temporary tracheotomy. The etiologic factors were significantly different for the two entities under study. Additional sites of stenosis were more frequent in ACF patients. Stenosis due to RLNP could be managed endoscopically without preliminary tracheotomy, while ACF frequently required open surgery and temporary tracheotomy.
Adult↗
Immunohistochemical expression of VEGF and VEGF receptors in nasal polyps as compared to normal turbinate mucosa.
The factors involved in the development of chronic inflammation and edema in nasal polyps remain to be clarified. The expression of vascular endothelial growth factor (VEGF) has been described in plasma cells, suggesting that plasma cells may play a major role in the development of edema in nasal polyps through the production of VEGF. We performed immunohistochemical analysis using specific antibodies to VEGF and to the known VEGF receptors, VEGFR-1 and VEGFR-2, on paraffin sections of human nasal polyps ( n=11) and controls of human mucosa of the normal middle turbinates ( n=6). In normal turbinate mucosa, sporadic immunostaining for VEGF was observed throughout the endothelial cells of the small veins and arteries. VEGFR-1 and VEGFR-2 expression was faint in the healthy turbinates. In nasal polyp tissues, strong immunostaining for VEGF was found in the endothelium of blood vessels and in the infiltrating perivascular inflammatory cells. Fibroblasts also stained for VEGF. Strong immunolabeling to VEGFR-1 was evident in the vascular endothelium, whereas weak to moderate VEGFR-1-staining was generally confined to scattered mononuclear round cells. Mononuclear round cells and the endothelium of capillaries revealed immunoreactivity to VEGFR-2. These findings support a role for VEGF and its receptors, VEGFR-1 and VEGFR-2, in the development and perpetuation of edema and angiogenesis in nasal polyps.
Endothelial Growth Factors↗
Rupture of the larynx in a newborn.
BACKGROUND: Lesions of the laryngotrachea due to repeated intubation trauma after birth are reported. CASE: A macrosomic neonate was born at term after uneventful pregnancy. On the basis of diminished uterine contractions and arrest of descent, the head was delivered by using obstetric forceps. No intubation was attempted after birth. Ten hours later, the infant developed acute life-threatening respiratory distress and subcutaneous emphysema. Intubation was impossible. Open surgical exploration of the neck revealed a rupture of the cricothyroid ligament within the larynx. The defect was closed immediately, and after artificial ventilation for 7 days, the infant was extubated. One year later, the child is developing satisfactorily, without stridor or hoarseness. CONCLUSION: In macrosomic neonates after traumatic delivery, a laryngotracheal lesion should be considered when respiratory distress syndrome combined with subcutaneous emphysema occurs.
Birth Injuries↗
Complications of suspension laryngoscopy.
Although suspension laryngoscopy (SL) is routinely used in operative laryngology, no prospectively gathered data on the complications of this procedure have so far been available. We prospectively analyzed 339 consecutive procedures for intervention-related complications. The survey included preoperative dental status and assessment of postoperative dental, mucosal, and nerve injuries. Minor mucosal lesions were found in 75% of all patients. All healed spontaneously within a few days. Dental injuries occurred in 6.5% of all patients. These were more frequent in therapeutic laryngoscopy than in diagnostic procedures (6.8% versus 6.0%). Highly significant correlations were found between dental injury rate and preoperative dental disease (p < .04) and grade of periodontitis (p <.001). Temporary nerve lesions were observed in 13 patients (9 of the lingual nerve and 4 of the hypoglossal nerve). Although minor complications frequently occur during SL, it is a relatively safe procedure with a low risk of significant morbidity.
Adult↗