Foix-Chavany-Marie-syndrome — neurological,neuropsychological, CT,MRI, and SPECT findings in a case progressive for more than 10 years

Summary In a 66-year-old woman signs and symptoms of bilateral opercular syndrome (Foix-Chavany-Marie-syndrome) developed progressively over a period of more than 10 years. Facio-linguo-velo-pharyngeo-masticatory diplegia with automatic-vol-untary dissociation was accompanied by motor aphasia and oral apraxia leading to a state of almost complete anarthria. Although it initially resembled the anterior biopercular syndrome there are also features indicating involvement of the posterior opercula. Although the aetiology remains obscure without pathological data, a bilateral focal brain atrophy is assumed. This is probably the first case documented by MRI and SPECT.Supported by the Hirnliga, Heidelberg, Federal Republic of Germany     

Piezoelectric shock wave lithotripsy of salivary gland stones: an in vitro feasibility study

The feasibility of fragmentation of salivary stones by a new extracorporeal piezoelectric lithotripter was investigated. A total of 40 salivary stones were submitted to piezoelectric shock wave treatment. The diameter, weight, and volume of all the stones were determined prior to shock wave administration. After shock wave administration the chemical composition of the stones was investigated by X-ray diffractometry. Fragmentation was achieved in 35 out of the 40 (87.5%) stones. Twenty-five of the 40 (62.5%) stones were disintegrated "therapeutically adequate" (residual fragments less than 1.5 mm). A statistically significant correlation was not observed between the number of discharges required for disintegration and the diameter, weight, volume, or the chemical composition of the stones.     

Cytotoxic and anti-proliferative effects of high-energy pulsed ultrasound (HEPUS) on human squamous cell carcinoma cells as compared to connective tissue fibroblasts

The cytotoxic and anti-proliferative effects of high-energy pulsed ultrasound (HEPUS) on human squamous cell carcinoma cells cloned from the hypopharynx (FaDu) and benign connective tissue cells (fibroblasts) were investigated in vitro. Sonication was carried out using an experimental piezoelectric, self-focusing burst-signal transducer. To increase the induction of cavitation, the transducer used was specifically designed to produce multiple oscillations with a high negative pressure amplitude. In both cell lines tested, the application of 100, 800 and 2000 pulses resulted in a high reduction of vital cells. After 2000 pulses, 4.0 ± 1.1% of the fibroblasts but only 2.0 ± 0.4% of the FaDu cells survived HEPUS exposure. A postexposure inhibiting effect of HEPUS for 10 days on the proliferation of surviving cells was noted for the FaDu cells exposed to 2000 pulses, but not as much for the fibroblasts. These findings support the hypothesis that human squamous cell carcinoma cells of the hypopharynx might be more sensitive to HEPUS than fibroblasts and that total tumor cell ablation might be possible in vitro given a sufficient number of HEPUS pulses. Received: 18 November 1997 / Accepted: 21 April 1998     

Outcomes of transoral laser microsurgery and transoral robotic surgery in oropharyngeal squamous cell carcinoma

ObjectiveTransoral robotic surgery (TORS) has evolved to a standard therapy modality for oropharyngeal carcinoma, especially in T1/ T2 tumors involving the base of the tongue due to its advantages compared with open surgery. However, knowledge about its benefits compared with transoral laser microsurgery (TLM) are scarce. This study compares oncological and functional results of TLM or TORS in the treatment of oropharyngeal squamous cell carcinoma (OPSCC).MethodsThis retrospective analysis comprises all patients with OPSCC treated with TLM (n = 30) or TORS (n = 24) between April 2003 and May 2018 (follow-up 43 ± 38.3 months). Both treatment groups (TLM and TORS) were comparable in terms of the stage of the disease, prognosis-determining factors, and adjuvant therapy modalities.ResultsThere were no significant differences regarding to the resection status (p = 0.272), the rate of local- (p = 0.834) and distant- recurrence (p = 0.416), with a disease-free survival of 86.7 % and 87.5 %, respectively (p = 0.892). In addition, we could not confirm any differences regarding to operating time (p = 0.860), intraoperative blood loss (p = 0.660), inpatient stay (p = 0.585) and postoperative bleeding rate (p = 0.245). The frequency of tracheostomy and percutaneous endoscopic gastrostomy between both groups is comparable, with a longer duration of tube feeding in patients who have received TLM (p = 0.030).ConclusionIn conclusion, TORS allows for similar oncological outcomes compared with TLM at comparable perioperative risks. The postoperative swallowing function may benefit from TORS.     

Preoperative diagnosis of neck tumors using magnetic resonance imaging

The value of magnetic resonance imaging (MRI) in preoperative diagnostics of neck tumours is described. The MR findings were compared with CT scans with respect to their significance for surgical treatment. The quality of the images of the neck was improved by the introduction of Helmholtz coils. The marked contrast between tumour and surrounding tissues provides detailed information about the extension, structure and extent of infiltration. However neither MR nor CT imaging was reliable in small laryngeal and hypopharyngeal carcinomas. The value of MR angiography cannot yet be determined.     

Intra-oral sonography in neoplasms of the mouth and base of the tongue

Sonography has proved superior to CT and MRI for imaging T1 or T2 carcinomas of the oral cavity and base of the tongue. However, in examining the anterior half of the tongue and the floor of the mouth problems arise due to absorption of sound by the mandible and air inclusion. Ultrasound examination can be performed end-orally by means of a miniaturised transducer. End-oral sonography produces images of the anterior parts of the tongue and the floor of the mouth without artefacts. This method is superior to conventional transcutaneous sonography for this region.     

Grundlagen und Konzepte zur enteralen Ernährung von HNO-Patienten

Patients suffering from head and neck cancer often show malnutrition even at the time of diagnosis. Therapeutic measures as surgery, radiation and antineoplastic chemotherapy additionally decrease the nutritional status. Therefore, an early supportive intervention is necessary in accordance to prognosis and quality of life. For many reasons, enteral nutrition has advantages to total parenteral nutrition. Percutaneous endoscopically guided gastrostomy (PEG) is the method of choice, for the application of enteral nutrition in most cases; special situations can be covered by using nasogastral feeding tubes, jejunostomy techniques, open surgical approach or radiologically guided gastrostomy. The industry provides a lot of different products suitable for nearly all patients. Furthermore, PEG facilitates the application of pharmacological agents, e.g. analgetics. However, the patient must be integrated in a network of professional care to ensure a safe nutrition therapy also in an outpatient setting.