Maligne Tumoren der Mundhöhle und des Oropharynx Stadieneinteilung

Zusammenfassung Um sich mit der Stadieneinteilung maligner Tumoren von Mundh?hle und Oropharynx vertraut zu machen, bedarf es einerseits einer sehr grundlegenden Kenntnis der normalen Anatomie und der bevorzugten Ausbreitungswege in den verschiedenen Tumorlokalisationen, andrerseits ein fundiertes Wissen um die Aussagekraft der g?ngigen Untersuchungsmodalit?ten. Trotz rasanter Fortschritte soll sich die Bildgebung nicht anma?en, die Histologie ersetzen zu k?nnen. Wichtiger als pr?operativ die Dignit?t festzustellen ist es jedoch, die Tumorgrenzen so genau wie m?glich zu definieren und von ?dematosen und narbigen Ver?nderungen zu unterscheiden, um wirkliche klinische Konsequenzen zu setzen.      

Wert der Spiral-CT im Staging von Karzinomen der Mundhöhle und des Oro- und Hypopharynx

Purpose. To compare spiral and conventional CT in the staging of carcinomas of the oral cavity, the oropharynx and hypopharynx. Method. Retrospectively 101 conventional CTs and prospectively 107 spiral CTs were analyzed regarding to correct T and N staging. CT results were compared with histological staging. Results. In conventional CT, there were correctly staged 85% of T stages (T1 62%, T2 74%, T3 81%, T4 94%) and 85% of N stages (N0 79%, N1 71%, N2 89%, N3 94%). Spiral CT showed correct results in 84% of T stages (T1 67%, T2 74%, T3 88%, T4 95%) and in 86% of N stages (N0 82%, N1 78%, N2 90%, N3 93%). No statistically significant differences could be found between both CT methods. Conclusion. In spite of the tendency of improved diagnosis of T1, N0 and N1 stages no clear improvement in the staging of carcinomas of the oral cavity, the oropharynx and hypopharynx could be expected by spiral CT.     

Beurteilung der Lebensqualität von Patienten mit Plattenepithelkarzinomen der Mundhöhle

BACKGROUND: The treatment of oral cancer has a strong impact on the quality of life. In recent years different therapeutic concepts have been developed, these include preoperative simultaneous "neoadjuvant" radiochemotherapy (RCT) and one-stage surgery with tumor ablation and reconstruction. When considering long-term survival, there is substantial evidence that evidenced modality treatment including neoadjuvant RCT is superior to the primary surgical approach with postoperative radiation. PATIENTS AND METHODS: This longitudinal study prospectively evaluates quality of life in two groups consisting of 53 neoadjuvant and primarily surgically treated patients with oral cancer, using the quality-of-life core questionnaire (QLQ-C30) and the head and neck cancer module (H and N 35) of the European Organization for Research and Treatment of Cancer (EORTC). RESULTS: Postoperatively both groups showed a marked reduction in quality of life. 1 year later quality of life had equalized between the two groups to such an extent that the quality of life scores had almost reached the preoperative level. Both groups showed specific impairments in the symptom scales. In the neoadjuvant therapy group however, global health and the emotional status were reduced to a greater degree than in the other group. CONCLUSION: Temporary limitations in quality of life can be expected after tumor treatment of oral cancer as presented here. Neoadjuvant therapy concept is more aggressive and might result in a longer disease-free survival, but the restriction in quality of life is more severe. Primary goal is the eradication of the tumor. Nevertheless preservation or reconstruction of a maximum of function is essential for a high level of quality of life.     

Ein Aneurysma in der Bauchhöhle

Zusammenfassung Es wurde ein rupturierendes Aneurysma der Bauchhöhle beschrieben, das wohl aus einer peripheren Schlagader der Bauchhöhle entstanden und kongenital bedingt ist.Herrn Professor S.Ueno vom Gerichtsmedizinischen Institut und Herrn Professor Y.Tokoro vom Pathologischen Institut der hiesigen Universität danken wir für die wertvollen Hinweise.     

Verbrennungstod nach suizidaler Eröffnung der Bauchhöhle

Background

The forensic medical assessment of secondary combined suicides requires both the morphological differentiation between third party and self-mutilation as well as the assessment of a possible capacity to act after an unsuccessful first suicide attempt.

Material and methods

This article presents a case report of a 40-year-old man who burned himself to death after a self-inflicted abdominal incision wound. Based on the results of the forensic analysis of the injuries together with the chemical toxicological investigation, crime scene and bloodstain pattern analysis, an external influence could be excluded.

Results and conclusion

This case illustrates the complexity of combined suicides and the importance of analyzing the plausibility of each of the possible actions leading to the victim’s death.

     

Milchige Flüssigkeit in der Brusthöhle

A chylothorax can occur as a rare complication of intensive care treatment and can lead to infection and thrombosis as well as to metabolic acidosis, electrolyte derangement and finally to respiratory insufficiency with potentially fatal outcome. In the following article the case of a 9-month-old female infant is described who died as a consequence of hypoxic brain damage after a 27-day period of intensive care treatment. The postmortem examination additionally showed a bilateral chylothorax mainly as a consequence of a traumatic iatrogenic injury in the context of bilateral positioning of central venous catheters (CVC).     

Die in der Bauchhöhle zurückgelassenen Fremdkörper im Lichte der Haftpflichtfrage

Ohne Zusammenfassung     

Das hinkende Kind Radiologische Differenzialdiagnostik der akuten Gangstörung des Kinder- und Jugendalters

Limping is a common and often challenging problem in children and adolescents. A limp is defined as asymetric deviation from a normal gait pattern. A systematic approach is necessary to determine the cause of the limp, so the radiologist should combine a thorough history, clinical information and pertinent radiologic testing. The possible differential diagnosis is extensive and includes many pathologies of the lower extremity and spine like trauma, infection, neoplasia, furthermore inflammatory, developmental and congenital disorders. In cases with knee or tight pain, an underlying hip condition should be considered. The childs age can narrow the possible differential diagnoses, because certain entities are age-related. Despite this wide bandwidth of entities, potential catastrophic causes like septic arthritis and malignant disease should be excluded first. Plain radiographs are often diagnostic. The choice of further imaging modalities like ultrasonography, magnetic resonance imaging, computed tomography and bone scan should be guided by the history and clinical findings.     

Änderungen der Hämoglobinkonzentration bei kombinierter Radio- und Chemotherapie lokal fortgeschrittener HNO-Tumoren

BACKGROUND: Despite multimodality treatment strategies of locally advanced head and neck cancers long-term results leave much to be desired. There is evidence that oxygenation status of head and neck tumors is directly influenced by the hemoglobin concentration. The aim of this study was to verify changes in the hemoglobin level during combined radio-chemotherapy of locally advanced head and neck tumors. PATIENTS AND METHODS: Sixty-eight patients with locally advanced head and neck cancer had primary or adjuvant radiotherapy with doses of 60 to 74 Gy in combination with cisplatin- (+/- 5-FU) or carboplatin chemotherapy in the first and fifth week of treatment. Hemoglobin levels were analyzed before and at the end of radiotherapy. RESULTS: In 41% of all patients the initial hemoglobin concentration was below normal levels. The mean hemoglobin values in all patients dropped significantly from 12.9 +/- 1.7 g/dl before to 11.6 +/- 1.6 g/dl at the end of treatment. In 12 cases (18%) allogeneic erythrocytes had to be transfused during treatment. At the end of treatment 76% of all patients had anemic hemoglobin levels. In the groups of patients with cisplatin and carboplatin chemotherapy a significant decrease in hemoglobin levels was seen without meaningful statistical difference between these 2 groups. CONCLUSIONS: In patients with locally advanced head and neck cancer a high initial rate of anemia was registered (41%): This rate was nearly doubled during chemoradiation (76%). Since several studies have shown a correlation between hemoglobin levels and local tumor control, there is evidence, that this group might benefit from correcting anemia before combined radio-chemotherapy.     

Zum Abbau des Tryptophans und Kynurenins Nach Ganzkörperbestrahlung im Lebergewebe der Maus

Summary

Es wurden die enzymatischen Aktivitäten der Tryptophanpyrrolase, Kynurenin Aminotransferase und Kynureninase im Lebergewebe normaler und hungernder Mäuse nach Bestrahlung mit 690 R Röntgenstrahlen gemessen. Die Aktivität der Tryptophanpyrrolase war 12–48 h p.r. erniedrigt sowohl bei den normal gefütterten Tieren als auch bei den hungernden Mäusen. Bis zum 12. Tag p.r. traten dann keine signifikanten Veränderungen auf.

Die Kynurenin Aminotransferase war leicht erhöht, während die Aktivität der Kynureninase vom 1.–4. und 7.–10. Tag p.r. stark abfiel. Damit verschob sich vor allem das regulierende Verhältnis dieser beiden Enzymaktivitäten im bestrahlten Tier. Diese Analogie zwischen Strahlenkrankheit und Vitamin B₆-Mangel-Syndrom wird diskutiert.     

Anatomie und Normvarianten der Nasennebenhöhlen in der Schnittbildgebung

CT and MRI are the radiological methods of choice in the diagnostics of diseases of the paranasal sinuses. Detailed anatomical knowledge is mandatory for correct image interpretation. Before endonasal surgery the individually variable anatomic situation has to be known. This article describes radiologically relevant anatomical structures and summarizes normal variations.     

Möglichkeiten der Optimierung des Workflows in radiologischen Abteilungen jenseits von RIS und PACS

Technological progress and the rising cost pressure on the healthcare system have led to a drastic change in the work environment of radiologists today. The pervasive demand for workflow optimization and increased efficiency of its activities raises the question of whether by employment of electronic systems, such as RIS and PACS, the potentials of digital technology are sufficiently used to fulfil this demand. This report describes the tasks and structures in radiology departments, which so far are only insufficiently supported by commercially available electronic systems but are nevertheless substantial. We developed and employed a web-based, integrated workplace system, which simplifies many daily tasks of departmental organization and administration apart from well-established tasks of documentation. Furthermore, we analyzed the effects exerted on departmental workflow by employment of this system for 3 years.     

Planungen der Deutschen Röntgengesellschaft und des Berufsverbandes zur Qualitätssicherung bei Mammographie

A high level of quality is an unequivocal prerequisite for obtaining the highest possible accuracy in symptomatic patients and for reproducing the results concerning mortality reduction, which were obtained in large screening trials. Present deficiencies in Germany are due to legal regulations, which have not been updated and which are thus below European standard. Furthermore the quality assurance program has not proven sufficiently effective for mammography. In order to promote mammographic quality assurance, the German Roentgen Society proposes an accreditation program. The accreditation, which concerns A.) mammographic technique and positioning and B.) mammographic reporting is not obligatory, but will allow acquisition of special official certificates, which may support the patients to find doctors who perform and read mammograms with high quality and expertise. The accreditation shall be performed by personnel and/or institutions who are specifically trained surveyed.