Venous thromboembolism in carriers of the Factor V Leiden mutation and in patients without known thrombophilic risk factor; prediction of recurrence and APC-PCI complex concentration and/or soluble thrombomodulin antigen and activity

BACKGROUND: The complex between activated protein C (APC) and the protein C inhibitor (PCI) is a sensitive indicator of the degree of activation of blood coagulation and higher concentrations have been measured in carriers of the FV Leiden mutation who were in the recovery phase after treatment for venous thromboembolism (VTE). OBJECTIVES: The main purpose of this study was to correlate the APC-PCI complex concentration to thrombomodulin activity and antigen concentration in the same group of patients. We also add a prospective clinical follow-up of the VTE recurrence after 1 year to investigate if the markers can predict the risk for a new VTE. PATIENTS/METHODS: Blood samples were collected from 50 patients with the FV Leiden mutation and 132 without any known risk factor for thrombophilia after finished treatment. RESULTS: The APC-PCI complex, s-TM activity and the quotient (s-TM activity)/(s-TM antigen) were higher in VTE patients with FV Leiden. In total, there were 19 VTE recurrences (10%) after 1 year. The OR for recurrence was 1.9 (95% CI 0.68-5.0) in all VTE patients with elevated APC-PCI complex (above 75th percentile) and 3.6 (95% CI 1.1-12) in VTE patients without any known risk factor for thrombophilia and with elevated s-TM activity. CONCLUSION: The APC-PCI complex concentration, s-TM activity and the quotient (s-TM activity)/(s-TM antigen) were higher in VTE patients with FV Leiden. The s-TM activity showed higher OR for recurrence of VTE in patients without known thrombophilic risk factor. Both methods could be sensitive markers of increased risk for venous thrombosis.     

Ergebnisse der hyperbaren Sauerstofftherapie bei therapieresistentem Tinnitus

Although many studies are available concerning the treatment of sudden deafness using hyperbaric oxygenation, only a few of these deal with tinnitus. The aim of the present study was to evaluate the therapeutic use of hyperbaric oxygenation in cases of tinnitus. A total of 193 patients, having undergone primary intravenous hemorheologic therapy, were treated with hyperbaric oxygenation. Tinnitus was evaluated before, after ten sessions and after 15 sessions using a tinnitus questionnaire. Additionally, an audiometric examination was performed. Measurable improvements of the tinnitus occurred in 22% of the patients, whereas a moderate improvement was seen in 17% of cases. 10.4% showed an excellent improvement and tinnitus disappeared completely in two patients. The improvement rate decreased in those cases where the time from onset of tinnitus exceeded 40 days. In conclusion, hyperbaric oxygenation seems to be a moderately effective additional treatment in the therapy of tinnitus after primary hemorheologic therapy, provided the time from onset of tinnitus is less than 1 month.     

Sonohistology for the computerized differentiation of parotid gland tumors

A system for the computerized differentiation of parotid gland tumors is proposed. The parotid gland is the largest of the salivary glands. It is found in the subcutaneous tissue of the face, overlying the mandibular ramus and anterior and inferior to the external ear. The classification system is based on a multifeature tissue characterization approach, using fuzzy inference systems as higher-order classifiers. Baseband ultrasonic echo data were acquired during conventional ultrasound imaging examinations using standard ultrasound equipment. Several tissue-describing parameters were calculated within numerous small regions of interest to evaluate spectral and textural tissue properties. The parameters were processed by an adaptive network-based fuzzy inference system, using the results of conventional histology after parotidectomy as the "gold standard." The results of the classification are presented as a numerical score indicating the probability of a certain tumor or alteration for each parotid gland. The score can be presented to the physician during examination of the patient to improve the differentiation between various types of parotid gland tumors. The system was evaluated on n = 23 cases of patients undergoing radical parotidectomy. The receiver operating characteristic curve area is A(ROC) = 0.95 +/- 0.07 when using fourfold cross-validation over cases and differentiating between various benign parotid gland tumors and monomorphic adenoma.     

Kalzifizierender Pseudotumor der Orbita

Orbital pseudotumor can be divided histopathologically into three basic types: lymphoid, granulomatous and sclerosing. Chronic lymphoid and granulomatous types may eventually transform into the sclerosing type. The calcifying orbital pseudotumor is a very rare disorder due to a chronic, idiopathic inflammatory process of the orbit. The granulomatous type shows a good response to steroids while radiotherapy is the method of choice for lymphoid lesions. In general, calcifying pseudotumors can be treated only by operative exploration and tumor removal. We report a patient with a calcifying pseudotumor of the orbital apex that was removed through an endonasal approach. Preoperative diagnostic procedures and differential diagnosis are discussed.     

Sperm protein 17 expression defines 2 subsets of primary esthesioneuroblastoma

Esthesioneuroblastomas (ENBs) are rare malignant tumors of the nasal vault, the origin, diagnosis, and management of which are still subjects of discussion. That there is no related prognostic factor or generally recognized therapeutic regimen highlights the need for further analyses of its underlying biologic features and investigations of new marker proteins that allow more reliable clinical testing. We here show that sperm protein 17 (Sp17) is expressed in the ciliated cells of the normal olfactory epithelium and in a proportion of primary ENB lesions. We found an association between Sp17 expression and metastases at relapse (P = .035), chromogranin expression (P = .014), and a female sex prevalence. A statistically nonsignificant relation was found between Sp17 and S-100, synaptophysin, and neurofilament expression. No correlation was also found between Sp17 expression and the proliferative capacity of the lesion that was evaluated by Ki-67 immunohistochemistry. The results of this study show the usefulness of Sp17 as a means of discriminating 2 subsets of primary ENB lesions and seem to suggest the existence of 2 distinct cell pathways in their origin and development.     

Kehlkopferhaltende Chirurgie bei Karzinomen der Rachenhinterwand durch Rekonstruktion mit freien Lappen

Zusammenfassung Bei der chirurgischen Entfernung von ausgedehnten Karzinomen der hypopharyngealen Rachenhinterwand stellt sich die Frage der Kehlkopfentfernung in erster Linie aus funktionellen Gründen. Zwischen 1994 und 1997 wurde allen Patienten mit einem Rachenhinterwandkarzinom des Hypopharynx und einer gesch?tzten Tumorausdehnung von mehr als 6 cm ein kehlkopferhaltendes chirurgisches Behandlungskonzept vorgeschlagen. Bei 9 Patienten mit T2 (n=2) und T4 (n=7) Karzinomen erfolgte nach lateraler Pharyngotomie eine Rekonstruktion der Rachenhinterwand mit freien Lappen (8 Unterarmlappen und 1 Dünndarmtransplantat). Die maximalen Tumorausdehnungen reichten von 6,5–12,5 cm. Bei der Pr?paration wurde versucht, den N. laryngeus superior zu erhalten und bei der Einnaht der freien Lappen fand die exakte Anpassung des Lappens an den Defekt besondere Beachtung. Bei 7 Patienten war innerhalb von 3 Monaten die Schluckfunktion so wiederhergestellt, da? die Ern?hrung oral erfolgen konnte. Ein Patient ben?tigte hierzu 4 Monate und ein Patient war 12 Monate postoperativ aufgrund von Aspirationen weiterhin nicht zur ausreichenden oralen Nahrungsaufnahme f?hig, 6 Patienten wurden bisher dekanüliert und in keinem Fall war in der Beobachtungszeit eine Laryngektomie aufgrund von Komplikationen oder auf Wunsch des Patienten erforderlich. Die funktionelle Rehabilitation nach der Entfernung ausgedehnter Rachenhinterwandkarzinome gelingt mit Hilfe von freien Lappen bei einem Gro?teil der Patienten. Eingegangen am 14. April 1997 Angenommen am 20. Oktober 1997