[Quality of life in patients with chronic rhinosinusitis: validation of the Sino-Nasal Outcome Test-20 German Adapted Version]

BACKGROUND

No validated German instrument for measuring health-related quality of life (QOL) in patients with chronic rhinosinusitis (CRS) has been available to date.

METHODS

The Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV) is a translated and adapted version of SNOT-20. To validate this instrument, we evaluated its reliability, validity and sensitivity. SNOT-20 GAV was completed by 163, 123, and 82 patients at the initial visit and at 3 months and 1 year after treatment commencement, respectively.

RESULTS

Cronbach's alpha indicated good internal consistency. Test-retest scores in 38 patients were highly correlated. Discrimination validity was demonstrated by a comparison with healthy controls. Sensitivity to change showed medium to large effects.

CONCLUSIONS

SNOT-20 GAV is the first reliable, validated and sensitive German instrument for measuring health-related QOL in patients with CRS.

[Quality of life in patients with oropharyngeal carcinoma. Gender influences the subjective evaluation]

BACKGROUND

The purpose of this study was to evaluate the impact of patient characteristics and surgical interventions on quality of life (QoL) after primary surgery and postoperative irradiation in patients with oropharyngeal carcinoma.

PATIENTS AND METHODS

Between January 1997 and February 2002, 169 patients with carcinoma of the oropharynx were treated with curative intent. In September 2002, a total of 88 disease-free survivors were identified and included in this study. A retrospective chart review was performed and patient responses to the SF-36 Health Survey, EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were evaluated. The questionnaires were completed by 34 patients (39% response rate).

RESULTS

All patients were treated with primary surgery followed by postoperative irradiation. The median follow-up was 2.3 years (range 0.5-4.9 years). Using Bonferroni-Holm adjustment for alpha, gender was found to be an important factor in QoL. Females scored significantly worse than males in all three questionnaires. We could not identify other factors influencing QoL.

CONCLUSION

The impact of gender on QoL must be considered as very significant.

Laryngotracheale Stenosen im Kindesalter

BACKGROUND

Stenoses of the larynx and upper trachea in the pediatric population require a multidisciplinary approach and center-based treatment. Patterns of care and treatment strategies in Germany were evaluated using a standardized questionnaire.

MATERIAL AND METHODS

A questionnaire was transmitted by telefax to 141 departments of Otorhinolaryngology (ORL) and to 214 pediatric (PED) departments. Using primarily multiple-choice questions variables regarding caseload, surgical techniques, cooperating institutions, criteria for surgical indications and subjective assessment of success rates were investigated.

RESULTS

The response rate was 55% (ORL) and 46% (PED), respectively, 34% of the replying ORL departments were offering tracheal surgery in children, with most of them using advanced surgical techniques. In 12 ORL departments 1-3 cases per year were operated, in 6 ORL departments more than 6 cases per year and 3 ORL departments were perceived as specialized centers for pediatric airway surgery by their peers. However, 41% of the PED departments were unable to identify a center for pediatric airway surgery.

CONCLUSION

In Germany, surgery for pediatric airway stenoses is not primarily focused on treatment centers. There is a significant information gap among German pediatricians regarding success rates of reconstructive airway surgery and available centers offering surgical therapy for this population. Several factors offer potential to be optimized in the care for children with a compromised airway and improving communication between otolaryngologists and pediatricians should be a primary goal in the future.

Patienten mit chronischer Rhinosinusitis

BACKGROUND

The negative effect of chronic rhinosinusitis on patient quality of life has been generally underappreciated and undervalued. So far, only a few studies have examined health-related quality of life at German language patient collectives with validated measuring instruments.

PATIENTS AND METHODS

Preoperatively, 163 patients were included into the study. Three months and 1 year after functional endonasal sinus surgery 123 and 82 patients, respectively, participated in the questioning. To measure health-related quality of life, we used version 20 of the German Adapted Version of the Sinonasal Outcome Test and the Short Form 36 Health Survey (SF-36). The German normative values of the SF-36 were used for analysis.

RESULTS

Postoperatively, a significant improvement in health-related quality of life was determined on all scales of both measuring instruments. Comparing our data with the German normative values of the SF-36, we found a lasting approximation of the average assessment levels in seven of eight scales.

CONCLUSION

Functional endonasal sinus surgery leads to significant improvements in disease-specific and general quality of life in patients with chronic rhinosinusitis.

Terminal deoxynucleotidyl transferase-positive cells in trephine biopsies following bone marrow or peripheral stem cell transplantation reflect vigorous B-cell generation

AIMS

Bone marrow is the major site of B-cell generation in humans. While in early childhood a high number of B-cell precursors is found in the bone marrow, only very few such cells are usually detectable in adult bone marrow. To assess the number of immature B cells present after haematopoietic cell transplantation the number of terminal deoxynucleotidyl transferase (TdT)-positive cells in regenerating bone marrow of adult patients was analysed.

METHODS AND RESULTS

Bone marrow biopsy specimens were analysed from patients after allogeneic bone marrow transplantation (BMT; n = 14) or stem cell transplantation (SCT; n = 25) and autologous BMT (n = 9). Specimens from 11 untransplanted adult patients and 11 infants were also studied, as negative and positive controls, respectively. Immunohistochemistry was performed on paraffin-embedded bone marrow biopsy sections using TdT as a marker of lymphoid progenitors. Immunoreactivity for CD79a, CD20 and CD10 was used to confirm their B-cell origin. Using computer-assisted automated image analysis we quantitatively assessed the TdT+ cells present. We found a significant increase in the numbers of B-cell precursors in the bone marrow after allogeneic and autologous BMT/SCT compared with adult controls (P = 0.022). To analyse this in detail, we followed some patients after allogeneic BMT/SCT for up to 1445 days, when a marked B-cell increase was still detectable. However, the median number of TdT+ B cells after BMT/SCT was significantly lower than the number of equivalent B cells in infantile bone marrow biopsy specimens (P < 0.001).

CONCLUSIONS

Bone marrow of adult patients after BMT/SCT is capable of initiating vigorous precursor B-cell generation, which is not seen in untransplanted adults. However, the increase of immature B cells was variable in our study. Only in two young adult patients did it reach the magnitude of B-cell generation seen in infantile bone marrow where immunocompetent B cells are produced normally. A marked increase in number of immature B cells post-transplant may mimic B-cell acute lymphoblastic leukaemia (B-ALL). This is a potential problem in patients transplanted for B-ALL itself. Since reactive and neoplastic B-cell precursors share the same immunophenotype in paraffin-embedded tissue, additional tools, particularly molecular techniques, may have to be employed to establish the correct diagnosis.

Evaluation of dysplastic features in myelodysplastic syndromes: experience from the morphology group of the European Working Group of MDS in Childhood (EWOG-MDS)

In the absence of genetic abnormalities, the diagnoses of myelodysplastic syndromes (MDS) is primarily based on the presence of dysplasia in blood and marrow cells. Currently, there is no standardized approach to evaluate dysplasia. International cooperative study groups like the European Working Group on MDS in Childhood (EWOG-MDS) depend, however, on a concordance in diagnoses by their national reference centres for morphology. In EWOG-MDS, the morphological diagnoses of all cases enrolled from Scandinavia, the Netherlands, Germany, the Czech Republic, Austria and Italy are established by five experienced pathologists or hematologists cooperating in a morphology board. To study their concordance in evaluating myelodysplastic disorders, members of the morphology board initiated blinded reviews of smears of blood and bone marrow aspirates of known cases. Four features of dysplasia in granulopoiesis, erythropoiesis and megakaryopoiesis were assessed on May-Grünwald-Giemsa stained smears. In a final review of six blinded cases, good concordance for these features was achieved among the five observers. Accurately defined and restrictively applied cellular features of dysplasia are an important tool to improve and ensure the concordance in the diagnosis of MDS among investigators. For cooperative groups, agreement on the evaluation of the morphological assessment of dysplasia is a prerequisite.

The International Prognostic Scoring System (IPSS) for childhood myelodysplastic syndrome (MDS) and juvenile myelomonocytic leukemia (JMML)

The International Prognostic Scoring System (IPSS) for myelodysplastic syndrome (MDS) is based upon weighted data on bone marrow (BM) blast percentage, cytopenia, and cytogenetics, separating patients into four prognostic groups. We analyzed the value of the IPSS in 142 children with de novo MDS and 166 children with juvenile myelomonocytic leukemia (JMML) enrolled in retro- and prospective studies of the European Working Group on childhood MDS (EWOG-MDS). Survivals in MDS and JMML were analyzed separately. Among the criteria considered by the IPSS score, only BM blasts <5% and platelets >100 x 10(9)/l were significantly associated with a superior survival in MDS. In JMML, better survival was associated with platelets >40 x 10(9)/l, but not with any other IPSS factors including cytogenetics. In conclusion, the IPSS is of limited value in both pediatric MDS and JMML. The results reflect the differences between myelodysplastic and myeloproliferative diseases in children and adults.

Acoustomechanical properties of open TTP® titanium middle ear prostheses

OBJECTIVE

The purpose of the study was to identify acoustcomechanical properties of various biostable and biocompatible materials to create a middle ear prosthesis with the following properties: (i) improved handling including a good view of the head of the stapes or footplate and adjustable length, (ii) improved acoustical characteristics that are adequate for ossiculoplastic. The identified material should serve to build CE and FDA approved prostheses for clinical use in patients.

METHODS

Test models made of Teflon, polyetheretherketone, polyethylenterephtalate, polysulfone, gold, Al2O3 ceramics, carbon and titanium were investigated for their potential to fulfill the requirements. Acoustical properties were investigated by laser Doppler velocimetry (LDV) in mechanical middle ear models (MMM). Measured data were fed in to a recently created computer model of the middle ear (multibody systems approach, MBS). Using computer-aided design (CAD) measured and computed data allowed creation and fine precision of titanium prostheses (Tübingen Titanium Protheses, TTP). Their handling was tested in temporal bones. Acoustomechanical properties were investigated using the MBS and mechanical middle ear models.

MAIN OUTCOME MEASURES

Input impedance, mass, stiffness, and geometry of test models and prostheses were determined. Furthermore, their influence on the intraprosthetic transfer functions and on coupling to either tympanic membrane or stapes was investigated.

RESULTS

Final results were FDA- and CE-approved filigreed titanium prostheses with an open head that fulfilled the four requirements detailed above. The prostheses (TTP) were developed in defined lengths of between 1.75 and 3.5 mm (partial) and 3.0 and 6.5 mm (total) as well as in adjustable lengths (TTP-Vario).

CONCLUSIONS

The results suggest acoustomechanical advantages of TTPs because they combine a significantly low mass with high stiffness. In contrast to closed prostheses, the open head and filigreed design allow an excellent view of the prosthesis foot during coupling to the head or footplate of stapes, contributing to an improved intraoperative reliability of prosthesis coupling.

A pediatric approach to the WHO classification of myelodysplastic and myeloproliferative diseases

Myelodysplastic and myeloproliferative disorders are rare in childhood and there is no widely accepted system for their diagnosis and classification. We propose minimal diagnostic criteria and a simple classification scheme which, while based on accepted morphological features and conforming with the recent suggestions of the WHO, allows for the special problems of myelodysplastic diseases in children. The classification recognizes three major diagnostic groups: (1) juvenile myelomonocytic leukemia (JMML), previously named chronic myelomonocytic leukemia (CMML) or juvenile chronic myeloid leukemia (JCML); (2) myeloid leukemia of Down syndrome, a disease with distinct clinical and biological features, encompassing both MDS and AML occurring in Down syndrome; and (3) MDS occurring both de novo and as a complication of previous therapy or pre-existing bone marrow disorder (secondary MDS). The main subtypes of MDS are refractory cytopenia (RC) and refractory anemia with excess of blasts (RAEB). It is suggested retaining the subtype of RAEB-T with 20-30% blasts in the marrow until more data are available. Cytogenetics and serial assessments of the patients are essential adjuncts to morphology both in diagnosis and classification.

[Pharyngeal reconstruction after salvage pharyngolaryngectomy in recurrent tumors]

BACKGROUND

Total pharyngeal reconstruction after salvage pharyngolarynectomy in recurrent tumors after primary surgery or radiation therapy may be performed by ENT surgeons in the oncologic field.

PATIENTS

We report on six patients that underwent salvage pharyngolaryngectomy and total pharyngeal reconstruction.

METHODS

In three cases pharyngeal reconstruction was performed as a two-stage procedure with deltopectoral flaps. One of these patients died before the completion of reconstruction. In three other patients the reconstruction was performed with a tubed pectoralis major myocutaneous flap including one patient after a failed reconstruction with a jejunum segment. or fistula prevention we applied silicon stents in three patients and self-expanding Nitinol stents in three other patients.

RESULTS

Of five successfully reconstructed patients two fed orally, one fed combined orally and via PEG and two fed via PEG.

CONCLUSIONS

Summarizing our experiences the use of silicon tubes and nitinol stents has proved its worth. Experiences with a larger number of patients must be collected in the future.