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There is increasing evidence worldwide that human papillomavirus is a major risk factor for head and neck cancer. Only few studies on this association have been performed in Germany to date. For the purposes of the present study, tumor specimens from 223 patients with squamous cell cancer of the oral cavity, oropharynx, hypopharynx and larynx were analyzed for HPV DNA and p16INK4a expression. The prevalence of HPV genotype 16 (HPV16) DNA in the study population was 17.5%. Further high-risk HPV types were not detected. All HPV16-positive tumors showed intense p16INK4a expression. HPV16 prevalence was highest in tonsillar carcinoma (37.5%) and lowest in laryngeal cancer (2.8%). We observed a significantly higher incidence of cervical lymph node metastases in patients with HPV16-positive tonsillar carcinoma in comparison to HPV-negative tumors (p0.016). Tobacco and/or alcohol consumption was significantly lower in patients with HPV-positive tumors (p0.0001).

Balloon dilation has become established as a novel method for managing chronic ventilatory dysfunction of the Eustachian tube. This treatment has so far not been used in children. This article presents the first case of a pediatric patient who required antibiotics for recurrent middle ear infections and was successfully treated with Eustachian tube dilation. After a single dilation the patient was almost free of symptoms. Further studies are required in order to establish this treatment in the management of children with recurrent ventilatory dysfunction of the Eustachian tube which does not respond to conventional therapy and to define existing and potential new indications for this treatment approach.

Balloon dilation is a novel method in the management of chronic Eustachian tube dysfunction. Routine preoperative CT has been recommended in order to rule out possible bone dehiscence in the region of the carotid canal or aneurysms of the internal carotid artery which can lead to vascular injuries and life-threatening bleeding or brain damage during the dilation procedure.We evaluated head CT scans of 1000 patients to assess the occurrence of carotid canal dehiscence, aneurysms or other vascular malformations and to measure the osseous part of the carotid canal.No dehiscence was noted in a total of 2000 boney carotid canals. The mean thickness of the carotid canal wall was 1.02 ± 0.29 mm. No aneurysms or vascular malformations were detected.The necessity of routine CT scans before balloon dilation should be critically discussed with a view to protecting patients from unnecessary radiation exposure and saving costs in the health care system.

Background So far, only few studies exist which investigated the influence of occupational factors on the risk of oral cancer. Patients A case control study enrolling 100 patients with carcinomas of the oral cavity and 400 randomized control persons was performed to analyze occupational risk factors for oral cancer. Results Twenty-two percent of the tumor patients and only 8.5% of the control persons were employed as machine workers. The relative risk for squamous cell carcinoma of the oral cavity was 3.4 (K.I.: 1.7-7.0) for machine workers (adjusted for alcohol and tobacco). Single case analysis showed that 96.3% of the machine workers with oral cancer and only 17.3% of the machine workers in the control group were exposed to dust, especially metal dust (55.5% vs. 9.7%). Also the exposure to paint, lacquer, and varnish containing chromium and nickel was significantly higher in machine workers with cancer of the oral cavity than in the machine workers without cancer (29.6% vs. 10.9%). Conclusions The findings suggest that exposition to various types of dust, especially metal dust, increases the risk of oral cancer in machine worker patients.

ZusammenfassungGerinnungsstörungen nach einem Polytrauma werden eine große Bedeutung für die weitere Prognose der Patienten beigemessen. In einer prospektiv angelegten Studie wurden bei 20 polytraumatisierten Patienten Gerinnungsund Fibrinolyseparameter analysiert, um deren Veränderungen während der präklinischen Phase zu definieren. Die Blutentnahmen wurden zum frühestmöglichen Zeitpunkt am Unfallort und bei Klinikübergabe durchgeführt. Die gewonnenen Proben wurden mit Hilfe eines speziell konzipierten »Kleinlabors« noch vor Ort verarbeitet, um möglichst native Meßwerte zu erhalten. Die Patienten wurden dem Schweregrad der Verletzung entsprechend kategorisiert und hatten einen Verletzungsschweregrad nach NACA > IV und einen Injury Severity Score (ISS) > 20. Die Ergebnisse zeigen, daß bereits in der sehr frühen Phase nach Eintritt des Traumas schwerwiegende Veränderungen des Gerinnungsund Fibrinolysesystems eintreten. Die frühzeitige Thrombingenerierung führt zu einer Verbrauchskoagulopathie und reaktiven Hyperfibrinolyse. Zusätzlich erzeugt die Freisetzung von endothelständigem Tissue-type-Plasminogenaktivator eine primäre Hyperfibrinolyse. Die Veränderungen des Gerinnungsund Fibrinolysesystems in der frühen präklinischen Phase nach Polytrauma können zu schwerwiegenden klinischen Komplikationen wie Blutungen, thromboembolischen Komplikationen und zur Ausbildung von Schockorganen führen.

Hintergrund. Nachblutungen nach Tonsillektomie stellen nach wie vor eine mitunter lebensbedrohliche Komplikation dar. Inwieweit das gewahlte Anasthesieverfahren einen Einfluss auf das Nachblutungsrisiko hat, wurde in der deutschsprachigen Literatur bisher nicht untersucht. Methode. Im Rahmen einer prospektiven Untersuchung wurde der Einfluss des Anasthesieverfahrens auf das Nachblutungsrisiko nach Tonsillektomie analysiert. Ergebnisse. In die vergleichende Untersuchung wurden insgesamt 1063 Patienten einbezogen. Bei 16 (4,12%) von 388 in Vollnarkose und 51 (7,55%) von 675 in Lokalanasthesie tonsillektomierten Patienten kam es zu einer Nachblutung. Eine primare Nachblutung (innerhalb von 24 h) trat bei 46 von 51 in Lokalanasthesie und bei 9 von 16 in Vollnarkose tonsillektomierten Patienten auf. Eine sekundare Nachblutung trat bei 5 von 51 in Lokalanasthesie operierten Patienten und bei 7 von 16 in Vollnarkose operierten Patienten auf. Diskussion. Postoperative Nachblutungen traten nach lokaler Betaubung haufiger auf als nach Vollnarkose. Dabei konnten nach Lokalanasthesie keine Spatblutungen nach dem 6. postoperativen Tag beobachtet werden, nach Vollnarkose traten dagegen 6 von 16 Nachblutungen ab dem 6. Tag (44%) auf.

In recent decades, acoustic shock and explosion traumas have increased in frequency in the general population. Beside the use of fireworks and firearms, airbag ignitions and explosions caused by terror or suicidal acts are also relevant. Depending on duration and strength of the sound pressure affecting the human ear, isolated inner ear damage or additional ear drum perforation and interruption of the middle ear ossicle chain can result. By means of otoscopy, pure tone audiometry, measurement of otoacoustic emissions, and other neurootological examinations, the severity of the trauma can be determined. With prompt and adequate therapy, permanent hearing loss can be minimized. In particular, the measurement of otoacoustic emissions allows conclusions to be made on the functionality of the outer hair cells which are damaged first in most cases. Histological investigations on noise-exposed cochleas show extensive damage to the outer hair cells in the frequency range between 1.0 and 4.0 kHz, which correlates well with audiometric measurements.

Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. Since several organ structures, such as the eyes, midface, pharynx, larynx, trachea, esophagus, nerves, vessels and vertebral spine can be injured at the same time, patients should be referred to a specialized trauma center for interdisciplinary treatment following emergency treatment. High-speed ballistic injuries were once confined to the battle field and have been uncommon in Europe since World War II. For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.

Cervicofacial actinomycosis is an uncommon infection and in most cases odontogenic in origin. Pharyngeal and/or laryngeal lesions, usually occurring secondary to mucosal trauma, are very rare and may mimic a malignant tumor. In such cases, which represent less than 1% of all cases, the differential diagnosis with upper aerodigestive tract malignancy remains challenging. We report a case of actinomycosis in a 56-year-old male patient who presented with an extensive, centrally necrotic mass in the oropharynx, hypopharynx and larynx region suspected to be a tumor. The lesion was diagnosed 6 months following accidental ingestion of an ear of corn and ultimately proved to be cervicofacial actinomycosis. The clinical and pathological features and current aspects of the diagnosis and treatment of cervicofacial actinomycosis are discussed.

The parotid gland is most commonly involved in bacterial sialadenitis. Predisposing factors for the ductally ascending infection, are dehydration, xerogenic drugs and salivary gland diseases associated with ductal obstructions or reduced saliva secretion. In the majority of cases the infection is caused by Staphylococcus aureus. However, a variety of other aerobic and anaerobic pathogens may be involved. Besides hydration, elimination of ductal obstruction and stimulation of saliva flow antibiotic treatment according to antibiogram is essential. In selected cases, for instance if a salivary gland abscess develops, surgical treatment may become necessary. Actinomycosis, tuberculosis and atypical mycobacteriosis are rare variations of bacterial sialadenitis which clinically may resemble a salivary gland tumor.

Horen zu konnen, ist von allen Sinneswahrnehmungen die wichtigste Voraussetzung fur die geistige Entwicklung des Menschen und fur ein sozial integrierendes Leben in der Gesellschaft. Rund 14 Millionen Menschen in Deutschland leiden unter mehr oder minder starker Schwerhorigkeit. Ohne Behandlung entstehen bei Kindern Sprachentwicklungsstorungen, bei Erwachsenen droht die soziale Isolation.

Coagulation changes due to polytrauma are considered to be an important determinant for the outcome. In this context, physiological inhibitors of activated coagulation are highlighted with special reference to antithrombin-III (AT-III). Blood samples of 20 randomly selected adults with polytrauma (Injury Severity Score mean = 36.7 +/- 8.6) were investigated. To investigate the very early onset of coagulation changes, samples were taken as early as possible at the site of emergency (mean = 18.3 +/- 5.5 min. after trauma) as well as at hospital admission (mean = 78.0 +/- 10.4 min.). By means of a specially designed "mini-lab", basic processing of the samples harvested (centrifugation, pipetting, freezing) was done on the spot to obtain haemostaseological results that agree as closely as possible with the subsequent analyses. Due to the activation of intravascular coagulation as well as the consumption of physiological inhibitors, comprehensive coagulation disturbances become obvious at the time of hospital admission. These are intensified by haemodilution as a consequence of high-dose fluid replacement. However, significantly elevated levels of specific coagulation reaction products (thrombin-antithrombin-III-complex) give evidence of the consumption of inhibitory potential exceeding haemodilution.

Die vorliegende Kasuistik beschreibt den Fall eines 35jahrigen Patienten, der sich mit einer wassrigen Nasensekretion, rezidivierender Epistaxis und einer langsam progredienten, linksbetonten Nasenatmungsbehinderung in der HNO-Abteilung des BwK Ulm zur Abklarung vorstellte. Die klinische Untersuchung sowie das CT der Nasennebenhohlen zeigten einen Tumor, der die komplette linke Nasenhaupthohle ausfullte und offenbar vom mittleren Nasengang ausging. Der Tumor wurde uber ein Midfacial degloving in toto reseziert. Die histologische Aufarbeitung ergab die Diagnose eines Neurinoms. Anhand dieser Kasuistik und einer Ubersicht uber die Literatur wird die Diagnostik und die Therapie dieses seltenen Nasentumors dargestellt.

Penetrating gunshot neck injuries present a serious challenge for the primary attending surgeon. By means of a case treated in the German Field Hospital in Mazar-e-Sharif (northern Afghanistan) and a review of the literature, the principles of diagnosis and treatment of penetrating zone II neck injuries due to gunshots or shrapnel are presented.

In recent years semi-implantable hearing aids have become an established option in the treatment of sensorineural hearing loss. In Germany two semi-implantable systems are available, namely the MedEl Soundbridge system and the Otologics MET system, both of which are active middle ear implants. Since 1996 almost 3,500 Soundbridge systems and 300 MET systems have been implanted world-wide. The majority of patients who have received semi-implantable hearing aids consider them to be superior to conventional hearing aids in many respects. Reported benefits include improved speech intelligibility (especially in noise), better sound quality, a more natural sounding own voice and the general advantages of an open ear canal. Implantable hearing systems can be used for a wider range of indications than conventional hearing aids. They are particularly useful in the treatment of patients with high-frequency hearing loss and patients with combined hearing loss. An analysis of the hearing outcomes that have thus far been reported for all patients with a hearing implant shows an average improvement in the hearing threshold by 15 dB, which corresponds to an improvement in hearing of more than 30%. As a consequence semi-implantable hearing systems are an excellent addition to the existing range of conventional hearing aids.

Within the last decades a considerable amount of epidemologic evidence has been built up to implicate chronic alcohol consumption as a major risk factor not only for oral and pharyngeal cancer, but also for laryngeal cancer. The mechanisms that underlie alcohol-related cancers of the larynx have remained largely unclear. Since the epithelium of the glottic region normally has no direct contact with alcoholic beverages, alcohol-related alterations of glottic mucosa have been questioned. In the present study 20 male Wistar rats were fed nutritionally adequate liquid diets containing 36% of the total calories either as ethanol or isocaloric carbohydrates for 6 months. Morphometric analysis of the glottic mucosa in the ethanol-fed rats showed a significant reduction in epithelial thickness of the glottic epithelium of the anterior commissure as well as of the posterior commissure (P < 0.001). Morphometric analysis of the basal cell nuclei of the glottic epithelium did not show any statistically significant differences between ethanol-fed rats and control rats. These findings indicate that chronic ethanol consumption can cause a significant atrophy of the glottic mucosal epithelium in the rat and suggest an enhanced susceptibility toward locally acting chemical carcinogens.

Bei einer 54jahrigen Patientin war es seit einigen Jahren zu einer fortschreitenden Horverschlechterung mit Tinnitus gekommen. Bei einer auswarts durchgefuhrten HNO-arztlichen Untersuchung fiel ohrmikroskopisch eine blaulich durchscheinende, pulsierende Struktur hinter dem rechten Trommelfell auf. Die in der Klinik durchgefuhrte bildgebende Diagnostik konnte einen Glomustumors nicht sicher ausschliesen. Daher wurde zur definitiven Klarung eine Probetympanotomie durchgefuhrt. Hierbei zeigte sich ein frei liegender Bulbus superior v. jugularis internae, der mehr als 1/3 der rechten Paukenhohle ausfullte.

Malignant melanomas (MMs) of the parotid gland are relatively uncommon. They occur almost invariably as metastases from a primary tumour located in the region of the scalp or the mucous membranes of the nose, paranasal sinuses, or throat. Primary MMs arising in the parotid gland are extremely rare. It is assumed that they originate in the glandular tissue or in intraglandular lymph nodes. We present a case report and review of the literature on the diagnosis, treatment, and prognosis of intraparotid malignant melanoma. Diagnosis is based primarily on B-scan ultrasonography and fine-needle aspiration cytology. Patients with a cytological diagnosis of MM are further evaluated by magnetic resonance imaging and positron emission tomography and receive a thorough ear-nose-throat and dermatological examination. The treatment of choice is total parotidectomy and selective neck dissection. The effectiveness of adjuvant treatments such as radiotherapy, chemotherapy, or immunotherapy remains controversial. Patients with primary MMs of the parotid gland appear to have a better prognosis than those with parotid metastases from melanomas of the skin or mucous membranes.

Etwa 1–8% aller bosartigen Tumormanifestationen im Bereich der Nasennebenhohlen sowie der Mundhohle sind Fernmetastasen verschiedener Primartumoren. Betroffen sind in erster Linie die Unterkieferregion (bis zu 90%) und die Oberkieferregion (5–20%). Als haufigste Primartumoren werden hierbei das Bronchialkarzinom und das Mammakarzinom beschrieben. Ein anderer, allerdings insgesamt sehr viel seltenerer bosartiger Tumor, der zwar uberwiegend in Lunge, Lymphknoten, Leber und Gehirn, gelegentlich aber auch in den Nasennebenhohlenbereich metastasiert, ist das Nierenzellkarzinom. In der vorliegenden Arbeit wird am Fallbeispiel eines 50jahrigen Patienten uber ein in die Stirnhohle und in die Siebbeinzellen metastasierendes Nierenzellkarzinom berichtet.

Pleomorphic adenomas of the parotid gland can be slowly growing over the course of many years and may reach an enormous and disfiguring size associated with significant morbidity of the patients. To our knowledge, over the last 80 years 20 cases of giant pleomorphic adenomas (weight 1.2-26.5 kg) have been reported. These tumors occurred predominantly in women (90%). The mean period from initial clinical manifestation until definitive surgical treatment was 20.7 years. The mean age of the patients at the time of surgery was 58.9 years. Malignant transformation occurred in 15.8% of cases. It is likely that the reasons for delayed treatment are the patient's fear of surgery on the one hand, and insufficient medical advise on the other. We report on a 77 year old female who had a 40-year history of a growing parotid tumor that weighed 3.9 kg after resection. The implications of this case for diagnosis and treatment of giant pleomorphic adenomas, and a review of the world literature on these unusual parotid tumors, are presented.

Malignant external otitis or skull base osteomyelitis and osteoradionecrosis of the skull base and the skull are potentially life-threatening conditions. The standard methods of treatment involve the use of antibiotics, local treatment and, where necessary, surgical excision of necrotic tissue. These approaches do not provide a complete cure in many cases. Severe functional deficits and even death can occur in advanced stages. We conducted a long-term retrospective follow-up study and report on a multimodal approach that we have been using with great success since 1987. The four cornerstones of this treatment are surgical debridement, combinations of antibiotics, specific immunoglobulins, and adjunctive hyperbaric oxygen therapy. This multimodal treatment approach has proved to be highly effective in improving the survival and quality of life of the patients concerned. These excellent outcomes justify the high costs that this therapy admittedly involves.

Fine-needle aspiration cytology (FNAC) is a minimally invasive procedure that offers high specifity and acceptable sensitivity in the preoperative diagnosis of parotid tumors. FNAC provides information that can be particularly valuable in surgical planning and patient education. In some cases, it may even help prevent unnecessary surgery. After an FNA procedure, on rare occasions, morphological changes in the tumor may be observed and can make a definitive histological examination difficult or even impossible.Histopathological changes in parotid tumors after preoperative FNAC are described on the basis of a case report and a survey of the literature.In rare cases, puncture-induced histopathological changes, such as hyalinization of the subepithelial stroma, necrosis and squamous metaplasia, so extensive that a definitive histological diagnosis is difficult, are observed. In the present case report, fine-needle aspiration of a 3 x 2 cm tumor, which had been classified as malignant on the basis of cytological findings, resulted in complete necrosis and made a definitive histological diagnosis impossible. Similar cases have been described by other authors in recent years.In rare cases, histological changes in the tumor tissue can occur after an FNA procedure, making a definitive histological examination difficult or even impossible. When a preoperative FNAC is performed, the pathologist in charge should be advised accordingly. In addition, patients should be informed about this infrequent risk before undergoing the procedure.

Leiomyosarcoma is usually found in the female genital tract, retroperitoneum, the wall of the gastrointestinal tract and subcutaneous tissues. An appearance of this malignant tumor in the larynx is extremely rare and may be difficult to diagnose. Because of its rarity, little information exists on management and prognosis. We report on a 64-year old male with a supraglottic leiomyosarcoma who was treated with supraglottic laryngectomy and postoperative radiotherapy. After 19 months the patient was well and free of disease. The most commonly used diagnostic and therapeutic procedures are analysed in a review of the 46 published cases of laryngeal leiomyosarcoma.

Balloon dilation has become established as a novel method for managing chronic ventilatory dysfunction of the Eustachian tube. This treatment has so far not been used in children. This article presents the first case of a pediatric patient who required antibiotics for recurrent middle ear infections and was successfully treated with Eustachian tube dilation. After a single dilation the patient was almost free of symptoms. Further studies are required in order to establish this treatment in the management of children with recurrent ventilatory dysfunction of the Eustachian tube which does not respond to conventional therapy and to define existing and potential new indications for this treatment approach.

Salivary duct carcinoma is a highly malignant tumor. Pain, facial nerve palsy, perineural and lymphatic invasion are common findings, as well as an extensive cervical lymph node involvement and distant metastasis. However, occasionally, as in the case presented, the clinical features of this tumor may resemble obstructive sialadenitis and thus cause a delay in appropriate treatment. Although salivary duct carcinoma exhibits an unpredictable clinical course and a poor overall prognosis, total parotidectomy with neck dissection and adjunctive radiation therapy appear to be appropriate for local and regional control of this aggressive neoplasm.

Background: Chronic ethanol consumption is associated with an increased risk of upper aerodigestive tract cancer. As acetaldehyde seems to be a carcinogenic factor associated with chronic alcohol consumption, alcoholics with the alcohol dehydrogenase (ADH) 1C*1 allele seem to be particularly at risk as this allele encodes for a rapidly ethanol metabolising enzyme leading to increased acetaldehyde levels. Recent epidemiological studies resulted in contradictory results and therefore we have investigated ADH1C genotypes in heavy alcohol consumers only. Methods: We analysed the ADH1C genotype in 107 heavy drinkers with upper aerodigestive tract cancer and in 103 age matched alcoholic controls without cancer who consumed similar amounts of alcohol. Genotyping of the ADH1C locus was performed using polymerase chain reaction based on restriction fragment length polymorphism methods on leucocyte DNA. In addition, ethanol was administered orally (0.3 g/kg body weight) to 21 healthy volunteers with the ADH1C*1,1, ADH1C*1,2, and ADH1C*2,2 genotypes, and 12 volunteers with various ADH genotypes consumed ethanol ad libitum (mean 211 (29) g). Subsequently, salivary acetaldehyde concentrations were measured by gas chromatography or high performance liquid chromatography. Results: The allele frequency of the ADH1C*1 allele was found to be significantly increased in heavy drinkers with upper aerodigestive tract cancer compared with age matched alcoholic controls without cancer (61.7% v 49.0%; p = 0.011). The unadjusted and adjusted odds ratios for all cancer cases versus all alcoholic controls were 1.67 and 1.69, respectively. Healthy volunteers homozygous for the ADH1C*1 allele had higher salivary acetaldehyde concentrations following alcohol ingestion than volunteers heterozygous for ADH1C (p = 0.056) or homozygous for ADH1C*2 (p = 0.011). Conclusions: These data demonstrate that heavy drinkers homozygous for the ADH1C*1 allele have a predisposition to develop upper aerodigestive tract cancer, possibly due to elevated salivary acetaldehyde levels following alcohol consumption.

Both sets of complaints, mouth dryness and a burning sensation of the oral mucosa, can have a variety of causes. Local and regional as well as systemic causes can be responsible for burning mouth syndrome. Diseases of the oral mucosa can have genetic, inflammatory, or neoplastic origins. Autoimmune diseases and allergies as well as different afflictions relating to internal medicine can be accompanied by a burning sensation in the oral mucosa. Neurological and psychiatric illnesses must be clarified during interdisciplinary diagnostics in order to identify idiopathic forms. The causes of mouth dryness are similarly complex. In addition to inadequate fluid intake, particularly in elderly patients, drug side effects or systemic diseases are frequently also responsible. Treatment is directed at the underlying disease; in ambiguous cases, symptomatic therapy can provide relief for medical complaints.

Our study included 52 patients who received follow-up care after laryngectomy; a Provox I prosthesis was used for voice rehabilitation.The EORTC Quality of Life Questionnaire was used to assess the postoperative quality of life of these patients with voice prostheses.Of the patients, 36.1% complained of a lack of energy, and 22% experienced sadness suggesting a reactive depression. Of the 55.6% of patients who expressed satisfaction with managing their disease, more than two-thirds were afraid of a potential deterioration of their health. More than 90% of the patients received extensive support from family and friends. As many as 52.8% expressed themselves satisfied with their current life, which is perhaps attributable to the successful rehabilitation of their voice. Eating problems, i.e., varying degrees of dysphagia as a result of treatment, were experienced by 47.3% of the patients.After the laryngectomy, 11% continue to smoke and 46% regularly consume alcohol. For this reason, rehabilitation measures should place more emphasis on patient education and on programs designed to help patients stop smoking and drinking alcohol.

Even today, necrotizing otitis externa is still a life-threatening condition. The standard treatment concepts based on antibiotic therapy, topical treatment and--if necessary--surgical debridement of necrotic tissue, remain ineffective in many cases. In advanced stages, necrotizing otitis externa can therefore be expected to result in severe functional impairment or even a fatal outcome.We describe our experience with a multimodal treatment concept that we have been using with great success at the Federal Armed Forces Hospital in Ulm since 1987. This treatment is based on four pillars: 1. Surgical debridement, 2. Use of a combination of antibiotics, and 3. Administration of specific immunoglobulins, accompanied by, 4. Hyperbaric oxygen therapyOver a period of more than 5 years 16 of the 22 patients treated on the basis of this multimodal concept remained free of recurrences. In addition, significant reductions in analgesic use and in the insulin doses needed by diabetic patients were possible.The treatment concept under scrutiny has proved particularly successful. The various modes involved and the results of this combined therapy are discussed.

B lymphocytes partially contribute to autoimmune type 1 diabetes (T1D) as a subset of APC with a preferential ability to trigger pathogenic CD4 T cells. We hypothesized that this resulted from the unique ability of B lymphocytes to take up pancreatic beta cell proteins through Ig mediated capture. T1D was significantly delayed, but not prevented, in a NOD stock in which the B lymphocyte Ig repertoire was strongly restricted because of the allelic exclusion induced by transgenic Ig molecules specific for the disease irrelevant hen egg lysozyme (HEL) protein (NOD.IgHEL mice). However, introducing the Ig(mu)null mutation to eliminate the small residual numbers of non-transgenic B lymphocytes in the NOD.IgHEL stock strongly suppressed T1D to the same low levels that characterize B lymphocyte deficient NOD.Ig(mu)null mice. In contrast to standard NOD mice, both the NOD.IgHEL.Ig(mu)null and NOD.Ig(mu)null stocks were unable to generate T cell responses against the candidate diabetes autoantigen, glutamic acid decarboxylase. These results indicate that Ig-mediated capture of beta cell autoantigens accounts for why B lymphocytes have a greater capacity than other APC subtypes to trigger diabetogenic T cells. Hence, defects in B lymphocyte, as well as T lymphocyte, tolerance induction mechanisms may contribute to T1D in NOD mice.

Experimental and epidemiological studies have provided evidence that pentachlorophenol (PCP) and gamma-hexachlorocyclohexane (lindane) may pose a potential carcinogenic risk for human epithelial cells of the upper aerodigestive tract. In the past, these two substances have been used for military and nonmilitary purposes, e.g., for impregnation of textiles and uniforms. In this study, we investigated the genotoxic effect of PCP and lindane on human mucosal tissue from the tonsils.In epithelia obtained from the tonsillar mucosa removed during surgery, cell viability was evaluated by trypan blue staining. The specimens were incubated for 60 min with PCP (0.3, 0.75, and 1.2 mM) and lindane (0.5, 0.75, and 1.0 mM). The induction of DNA damage (single- and double-strand breaks) caused by PCP and lindane was measured using single-cell microgel electrophoresis. Evaluation was performed with an image analyzer enhanced by fluorescence microscopy.After exposure to PCP and lindane, strong genotoxic effects are apparent. The DNA migration rose from 26 micrometer in the control solution up to nearly 90 micrometer after incubation with PCP and lindane ( p0.0001).This study could demonstrate for the first time genotoxic effects of PCP and lindane on human tonsillar epithelium. It has to be considered that chronic exposure to both agents might increase the risk for cancer of the upper aerodigestive tract.

A case-control study was conducted to investigate occupational and other risk factors for squamous cell carcinoma of the oral cavity, the pharynx and the larynx. The study included 209 male cancer patients and 110 male control persons without known malignant disease, matched for age, alcohol consumption and tobacco consumption.Cases and controls were interviewed using a standardized questionnaire which has been used before in the Heidelberg case-control studies.The educational level in the cancer group was significantly lower (p0.001). 17.2% of the cancer patients and 7.3% of the control persons had not completed their professional training. The percentage of so-called "blue-collar workers" was significantly higher in the cancer group (20.9% vs. 7.3%; p0.002). An increased cancer risk was observed for workers exposed to asbestos (OR = 8.7; p = 0.004) and cement dust (OR = 12.9; p0.001). A frequent consumption of various vegetable food like carrots (OR = 0.17; p0.001), fruits (OR = 0.38; p0.001) or green salad (OR = 0.25; p0.001) was associated with a significant reduction of cancer risk.

Postoperative bleeding after tonsillectomy is still a life-threatening problem. The incidence of postoperative bleeding, as well as many factors (kind of surgery, hemostasic problems) affecting this risk have been investigated. A possible factor that has not been well studied is the used anaesthetic procedure.A prospective study was completed comparing the risk of postoperative bleeding in patients operated in local vs. general anaesthesia.The study enrolled 1063 patients, who consecutively underwent tonsillectomy. In 16 (4.12%) of 388 patients operated under general and 51 (7.55%) of 675 patients operated under local anaesthesia postoperative bleeding occurred. After local anaesthesia postoperative bleeding was seen mainly at the day of operation (46 of 51), there was no late bleeding after the 6th postoperative day. After general anaesthesia in 6 of 16 cases postoperative bleeding occurred after the 6th postoperative day.Postoperative bleeding occurs more frequent in patients who underwent tonsillectomy in local anaesthesia. The risk of late postoperative bleeding however is higher with tonsillectomy in general anaesthesia.

In numerous experimental and epidemiologic studies Pentachlorphenol (PCP) and Hexachlorcyclohexan (Lindane) have been shown to be of potential carcinogenic risk for human epithelial cells. In the past, these two substances have been used for both, military and non-military purposes, e.g. for impregnation of textiles and uniforms. In this study we investigated the genotoxic effect of PCP and Lindane on human mucosal tissue from the middle and lower nasal turbinate.In biopsy samples obtained from nasal epithelia during surgery cell vitality was evaluated by trypan-blue-staining. The specimens were incubated for 60 minutes with PCP (0.3; 0.75 und 1.2 mumol/l) and Lindane (0.5; 0.75; and 1.0 mumol/ml). The induction of DNA-damage (single-strand-breaks and double-strand-breaks) caused by PCP and Lindane was measured using single-cell microgel electrophoresis. Evaluation was performed by fluorescence microscopy.Especially in mucosa cells from the middle turbinate severe DNA-damages were recognized after exposition to PCP and Lindane proposing a strong genotoxic effect. In cells from the lower turbinate DNA-changes caused by PCP and Lindane were significantly lower. However a considerable genotoxic effect was also present.This study shows for the first time that there are clear facts indicating mutagenic effects of PCP and Lindane on nasal epithelia. Furthermore, this is the first study showing different susceptibility of two anatomic subsites in the nose for different pesticides. Concerning the biological plausibility, this study offers important arguments for evaluating the role of PCP and Lindane in the induction of upper aerodigestive tract cancer.

A 35 years old male patient presented with serous nasal secretion, relapsing epistaxis and a slowly progredient nasal obstruction. Clinical examination and CT scans showed a tumor occupying the left middle meatus and the whole nasal cavity displosing the nasal septum to the right side. The tumor was resected by a midfacial degloving approach. Histological examination showed a neurinoma. By means of the presented case report and a review of literature, diagnosis and treatment of this rare nasal tumor are discussed.

We are investigating the feasibility of using HER2/neu encoding genetic vaccines to elicit potent CD4(+) and CD8(+) T cell reactivity for the prevention and treatment of breast cancer. Two strategies of genetic vaccination, each with distinct advantages, will be assessed. The first strategy entails the use of alphavirus Venezuelan equine encephalitis virus (VEE)-replicons which selectively infect dendritic cells in vivo. Dendritic cells are characterized by an exceptional capacity to initiate and establish potent T cell immunity. Our second strategy is to employ a plasmid DNA (pDNA) vaccine encoding HER2/neu. pDNA vaccination has been shown to be effective in inducing persistent T cell responses in various model systems. VEE-replicon and pDNA vaccines encoding cytokines such as IL-l2 and IL-18, will also be used to enhance anti-HER2/neu-specific CD4(+) Thi cell and CD8(+) CTL activity. To directly assess the efficacy of our approach to prevent tumor cell growth and/or eradicate established tumors, we will employ mice transgenic for a rat HER2/neu gene. These mice develop mammary tumors and pulmonary metastatic lesions. Furthermore, we will use mice transgenic for an HLA-A2.1 molecule to assess CD8(+) CTL reactivity to HER2/neu-specific peptide epitopes which have been proposed as targets for immunotherapy in a clinical setting.

Major risk factors for cancer of the oral cavity, pharynx and larynx are smoking and excess alcohol consumption. Since long-term survival rates of head and neck cancer patients have not substantially been improved, new preventive strategies including the use of cancer chemopreventive agents have to be developed. With the aim of developing biomarkers which can verify the efficacy of chemopreventive interventions, a standardised alkaline microgel electrophoresis (MGE) assay was applied as a sensitive and rapid tool to detect DNA damage on a single cell level. Macroscopically normal laryngeal mucosa biopsies obtained by surgery from head and neck cancer patients (n=29) and from hospital controls (n=22) were analysed by MGE in a pilot study. As compared to controls, cells from head and neck cancer patients showed a significantly elevated DNA damage without any further genotoxic treatment (P

Head- and neck-cancer is a multifactorial disease. Besides major risk factors like alcohol and tobacco consumption, occupational factors play a significant role. At present it is estimated that in western industrial nations about 4 to 10% of all head- and neck-cancer cases are caused by occupational exposures. Combined exposures to occupational and non-occupational risk factors as well as the interaction of different occupational agents may have a synergistic effect on the cancer risk. It is very likely that the cancer risk due to occupational factors is modulated by host factors like DNA repair capacity and enzymatically controlled activation and inactivation of carcinogens.

Workers in the construction industry carry an increased risk for head and neck cancer due to the high consumption of alcohol and tobacco plus exposure to occupational carcinogenic or co-carcinogenic agents. These latter substances include asbestos, tar products, metal dust, wood dust, cement dust and paints.The Heidelberg case-control studies showed a statistically increased risk of pharyngeal cancer (RR=2.5 adjusted for tobacco and alcohol) and laryngeal cancer (RR=2.3 adjusted for tobacco and alcohol) in the construction workers (23.3%) when compared to controls (8.2%). A random sample analysis of patients with head and neck cancer referred by the largest health assurance company in Heidelberg (AOK), revealed that 21.2% were employed in the construction industry. Similar results have been obtained in a number of international epidemiological studies.Our findings show that male construction workers who regularly consume alcohol and tobacco represent an extreme risk group for head and neck cancer. Measures for early detection are important and must be implemented carefully.