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The authors present a group of nine patients suffering from mesenteric venous thrombosis, which were treated in three hospitals with participation of the first author. Basic principles of diagnostic and therapeutic procedure are summarized and a shift in the treatment strategy over the last 10 years is pointed out. The patient after a very radical intestinal resection may expect to survive and entertain an acceptable quality of life, provided the surgery is followed by an extensive team care in the post-operation period, later accompanied by the care of specialists in modern ways of nutrition.

From October 1990 to March 1994, 90 patients entered a prospectively randomised trial in head and neck cancer. All patients had verified squamous cell carcinoma and were referred for primary radiation therapy. Tumours originated in the oral cavity in 25, oropharynx in 37, larynx in 15 and hypopharynx in 13 cases. Patients' stages were predominantely T3 and T4 (71/90) and had lymph node metastases (60/90). Seventy-nine male patients and 11 female patients, with a median age of 57 years (range 37-76 years) were treated. Patients were randomised to one of three treatment options: conventional fractionation (CF) consisting of 70 Gy in 35 fractions over 7 weeks or continuous hyperfractionated accelerated radiation therapy (Vienna-CHART) or Vienna-CHART with administration of a single dose of mitomycin C on day 5 of treatment (V-CHART + MMC). By the accelerated regimen a total dose of 55.3 Gy was given in 33 fractions within 17 consecutive days. Acute mucositis was the main toxicity recorded in those patients treated by accelerated fractionation, although the overall duration of mucosal reaction did not differ in the three treatment groups. There was no influence on local toxicity if MMC was added to radiation therapy or not. Those patients treated with additional MMC experienced a grade III/IV haematological toxicity in 4/28 cases. Complete remission (CR) was recorded in 48% following CF, 79% after Vienna-CHART (P < 0.05) and 71% after Vienna-CHART + MMC. The overall local failure rates were 73%, 59% and 42% (P = NS) for patients treated by CF, Vienna-CHART and Vienna-CHART + MMC respectively.

Based on our three years experience with about 200 transcutaneous real-time sonographies of the tongue and the floor of mouth, an assessment of the determination of size and site of 38 pretherapeutically examined malignant tumours (35 squamous cell carcinomas) was made. The patients were examined in reclined position, the head retroflected. Curved array transducers of 5 or 7.5 MHz and a silicon elastomer block as interface turned out to be optimal. All tumours could be detected by sonography as hypoechoic, more or less homogeneous, ill-defined areas. Two thirds of the tumour ulcerations could be seen as hard hyperechoic reflexes within the hypoechoic areas. When comparing the maximal diameter of tumours of the 20 operated patients, we found an agreement (5 mm tolerance) of sonography with the surgical specimen in 14 of 20 tumours (70%), of sonography with the clinically estimated diameter in 10 of 20 tumours (50%), whereas the clinically estimated diameter was in agreement with the surgical specimen in only 8 of 20 tumours (40%). A peritumoral inflammatory infiltration can simulate a larger tumour size in sonography. The extent of tumours within the tongue, to the floor of mouth, the lateral pharyngeal wall and the preepiglottic space was documented correctly in most cases. In three cases a previously unknown spread across the midline was found sonographically. Including the sonographic findings in the TNM classification, 5 T1 tumours would have been staged as T2 and one T3 tumour as T4. Inflammatory diseases of the tongue can show the same sonomorphology as malignant tumours.

92 sonographic examinations performed in 62 patients were evaluated to determine the possible application of sonography in the diagnosis and follow-up of malignant tumours of the tongue. Squamous cell carcinomas were by far dominant and proved to be hypoechoic, mainly inhomogeneous and ill-defined masses. In most cases, they ranged between 2 and 4 cm. in diameter. In 50% of the lesions an infiltration of the pharynx wall was confirmed, and exulcerations were correctly detected by sonography in 75%. In preoperative determination of the size of the tumour, sonography correctly detected the size in 93% of the cases and was thus markedly superior to the clinical palpatory examination, which determined a mere 43% correctly. Sonography should be included in the pretherapeutic staging of tumours of the tongue to objectify the clinical findings. It is also adequate to document tumour behaviour during radiation.