Fine-needle aspiration cytology of the sentinel lymph node in head and neck cancer.

In squamous cell carcinoma of the head and neck, staging of the neck cannot rule out occult metastatic disease. An improved staging is necessary to avoid elective neck dissection in patients staged as N0. The study was performed to determine the feasibility of the detection of occult metastatic disease by ultrasound-guided fine-needle aspiration cytology (USgFNAC) of sentinel lymph nodes (SLN). METHODS: Sixteen consecutive patients diagnosed with oral, oropharyngeal, or dermal squamous cell carcinoma who had been staged as N0 underwent lymphoscintigraphy in double tracer technique to localize SLNs. A USgFNAC was performed on SLNs before elective neck dissection. The results of USgFNAC were compared with pathohistologic findings, which were regarded as the gold standard. RESULTS: Seven of 16 patients were upstaged to N+ after histopathologic examination of the neck dissection specimen. In only 1 of these patients was metastatic disease detected by USgFNAC of the SLN. CONCLUSION: The combination of lymphoscintigraphy and USgFNAC of the SLN improves preselection of N+ patients and, thus, the staging procedures. However, based on present results this method does not seem reliable in deciding whether an elective neck dissection can be avoided. A biopsy of the SLN with close histopathologic work-up seems to be mandatory for the detection of occult metastatic disease, because the merely incidental aspiration of micrometastatic material within normal-sized lymph nodes results in a high number of false-negative results by USgFNAC.     

Eye-hand coordination in essential tremor.

Patients with essential tremor (ET) or with cerebellar lesions have in common oculomotor abnormalities, with the exception of saccadic eye movements, which do not seem to be involved in ET. Since grasping is prolonged in ET and might be related to saccadic dysmetria, we tested whether simultaneous hand pointing could unmask it. Twelve ET patients and 14 controls performed saccades with and without simultaneous pointing movements to the same targets, and with and without a gap between the disappearance of the fixation point and the appearance of the target. Eye movements were recorded with the magnetic search-coil method, hand movements with an ultrasound-emitting probe. ET patients did not have saccadic dysmetria, and contrary to normal subjects their saccadic latency did not decrease during combined eye-hand movements compared with saccades performed in isolation. Hand movements had a longer duration in ET patients, with decreased peak acceleration, an increased latency of the peak velocity, and peak deceleration. In conclusion, this first study on eye-hand coordination in ET revealed abnormal kinematic changes in the early phase of pointing movements. These changes might be related to cerebellar disease but they are independent of the intention tremor component and saccade performance.     

Effects of voluntary blinks on saccades,vergence eye movements,and saccade-vergence interactions in humans

Blinks are known to change the kinematic properties of horizontal saccades, probably by influencing the saccadic premotor circuit. The neuronal basis of this effect could be explained by changes in the activity of omnipause neurons in the nucleus raphe interpositus or in the saccade-related burst neurons of the superior colliculus. Omnipause neurons cease discharge during both saccades and vergence movements. Because eyelid blinks can influence both sets of neurons, we hypothesized that blinks would influence the kinematic parameters of saccades in all directions, vergence, and saccade-vergence interactions. To test this hypothesis, we investigated binocular eye and lid movements in five normal healthy subjects with the magnetic search coil technique. The subjects performed conjugate horizontal and vertical saccades from gaze straight ahead to targets at 20 degrees up, down, right, or left while either attempting not to blink or voluntarily blinking. While following the same blink instruction, subjects made horizontal vergence eye movements of 7 degrees and combined saccade-vergence movements with a version amplitude of 20 degrees. The movements were performed back and forth from two targets simultaneously presented nearby (38 cm) and more distant (145 cm). Small vertical saccades accompanied most vergence movements. These results show that blinks change the kinematics (saccade duration, peak velocity, peak acceleration, peak deceleration) of not only horizontal but also of vertical saccades, of horizontal vergence eye movements, and of combined saccade-vergence eye movements. Peak velocity, acceleration, and deceleration of eye movements were decreased on the average by 30%, and their duration increased by 43% on the average when they were accompanied by blinks. The blink effect was time dependent with respect to saccade and vergence onset: the greatest effect occurred 100 ms prior to saccade onset, whereas there was no effect when the blink started after saccade onset. The effects of blinks on saccades and vergence, which are tightly coupled to latency, support the hypothesis that blinks cause profound spatiotemporal perturbations of the eye movements by interfering with the normal saccade/vergence premotor circuits. However, the measured effect may to a certain degree but not exclusively be explained by mechanical interference.     

Pain sensitisers exhibit grey matter changes after repetitive pain exposure: A longitudinal voxel-based morphometry study

Previous research in health and disease has shown that exposure to pain changes the density of cortical grey matter (GM). Such structural changes of the brain might, however, depend crucially on how this pain experience is evaluated and processed in the brain. In the present study we aimed to detect pain-rating patterns and underlying GM changes after the application of repetitive painful stimulation using voxel-based morphometry (VBM). Healthy volunteers were investigated (n = 27), receiving 8 noxious and 8 innocuous thermal stimuli on the right forearm for 11 consecutive working days. Data were compared with a control group without any intervention (n = 18). Behavioural data demonstrated that a subgroup of volunteers (n = 14) sensitised, whereas the others (n = 13) habituated over the stimulation days. The VBM analysis revealed no increase but a significant reduction of GM density, eg, in the anterior cingulate cortex, the insular cortex and the frontal cortex, exclusively in the group of sensitisers. By contrast, pain habituaters did not show any density changes in the GM.     

Untersuchungen zur zerebralen Verarbeitung von Schmerzen mit funktioneller Bildgebung

Functional neuroimaging methods such as positron emission tomography (PET) or functional magnetic resonance imaging (fMRI) provide fascinating insights into the cerebral processing of pain. Neuroimaging studies have shown that no clearly defined “pain centre” exists. Rather, an entire network of brain regions is involved in the processing of nociceptive information, which leads to the subjective impression of “pain”. Sophisticated study designs nowadays permit the characterisation of different components of pain processing. In this review, we summarise neuroimaging studies, which contributed to the characterisation of these different aspects of cerebral pain processing, such as somatosensory (discrimination of different stimulus modalities, noxious vs non-noxious, summation), emotional, cognitive (attention, anticipation, distraction), vegetative (homeostasis) and motor aspects.     

Plasma lactoferrin levels are decreased in end-stage AIDS patients.

The antimicrobial protein lactoferrin (Lf) is present in plasma and in mucosal secretions. Using ELISA we analysed plasma and saliva of HIV-infected patients, patients with AIDS, and healthy controls for the presence of secreted Lf. The plasma Lf levels of AIDS patients (classification C3) were significantly lower (p < 0.001) as compared to asymptomatic and symptomatic HIV infected patients, or controls. In addition, plasma Lf levels closely correlated with neutrophilic granulocyte counts in the HIV-infected patients. Thus, basal plasma Lf levels are likely the result of Lf release by neutrophilic granulocytes. The Candida titres present in the oral cavity were determined in a part of the HIV-infected patient group. As it appeared, the presence of this opportunistic pathogen always coincided with low levels of salivary Lf levels. We conclude that Lf, as part of the nonspecific immune system, might play an important role in the first line of defense against opportunistic microbial infections in AIDS patients.