Long-term stability of regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: 10-year data of a retrospective study

BACKGROUND

This study aimed to evaluate the long-term effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) in stage IV periodontitis.

METHODS

Twenty-two patients with a total of 256 intra-bony defects were analyzed after regenerative surgery followed by OT initiated 3 months later. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1), final splinting (T2), and 10 years (T10).

RESULTS

Mean rBL gain was significant with 4.63 mm (±2.43 mm) after 1 year (T1), 4.19 mm (±2.61 mm) at final splinting (T2), and 4.48 mm (±2.62 mm) after 10 years (T10). Mean PPD was significantly reduced from 5.84 mm (±2.05 mm) at baseline to 3.19 mm (±1.23 mm) at T1, to 3.07 mm (±1.23 mm) at T2, and to 2.93 mm (±1.24 mm) at T10. Pocket closure (PPD ≤ 4 mm) was achieved in 90% of all defects. Tooth loss amounted to 4.5%.

CONCLUSIONS

Within the limitations of this retrospective study design, these 10-year findings suggest that in motivated and compliant patients with stage IV periodontitis and in need of OT an inter-disciplinary treatment can lead to favorable and stable long-term results.

Formation of protein adducts with Hydroperoxy-PE electrophilic cleavage products during ferroptosis

Ferroptosis is an iron dependent form of cell death, that is triggered by the discoordination of iron, lipids, and thiols. Its unique signature that distinguishes it from other forms of cell death is the formation and accumulation of lipid hydroperoxides, particularly oxidized forms of polyunsaturated phosphatidylethanolamines (PEs), which drives cell death. These readily undergo iron-catalyzed secondary free radical reactions leading to truncated products which retain the signature PE headgroup and which can readily react with nucleophilic moieties in proteins via their truncated electrophilic acyl chains. Using a redox lipidomics approach, we have identified oxidatively-truncated PE species (trPEox) in enzymatic and non-enzymatic model systems. Further, using a model peptide we demonstrate adduct formation with Cys as the preferred nucleophilic residue and PE(26:2) +2 oxygens, as one of the most reactive truncated PE-electrophiles produced. In cells stimulated to undergo ferroptosis we identified PE-truncated species with sn-2 truncations ranging from 5 to 9 carbons. Taking advantage of the free PE headgroup, we have developed a new technology using the lantibiotic duramycin, to enrich and identify the PE-lipoxidated proteins. Our results indicate that several dozens of proteins for each cell type, are PE-lipoxidated in HT-22, MLE, and H9c2 cells and M2 macrophages after they were induced to undergo ferroptosis. Pretreatment of cells with the strong nucleophile, 2-mercaptoethanol, prevented the formation of PE-lipoxidated proteins and blocked ferroptotic death. Finally, our docking simulations showed that the truncated PE species bound at least as good to several of the lantibiotic-identified proteins, as compared to the non-truncated parent molecule, stearoyl-arachidonoyl PE (SAPE), indicating that these oxidatively-truncated species favor/promote the formation of PEox-protein adducts. The identification of PEox-protein adducts during ferroptosis suggests that they are participants in the ferroptotic process preventable by 2-mercaptoethanol and may contribute to a point of no return in the ferroptotic death process.

Modified Acid Phosphatase Assay for Assessing the Extent of Heating of Canned Picnics and Hams: Interlaboratory Study

Determination of acid phosphatase (E.C. 3.1.3.2.) activity in meat and meat products Is based on spectrophotometric measurement of free phenol released from phenyl phosphate substrate during enzyme catalysis under prescribed conditions. Precision parameters of a new modified phosphatase assay, proposed for determination of extent of heating of canned picnics and hams, were evaluated in an interlaboratory study with 10 (1 German, 2 Italian, and 7 Hungarian) participating laboratories. The test materials were 5 lean meat batters subjected to different heat treatments (i.e., with different levels of phosphatase activity). The materials were presented to participants as 10 randomly coded samples (2 blind replicates of each material). The interlaboratory study was then repeated with 3 test materials and 2 blind replicates (3 × 2) prepared in the same way. The repeatability relative standard deviation (RSDr), outliers excluded, varied from 2.2 to 10.7%, and the reproducibility relative standard deviation (RSDR) varied from 12.6 to 25.3%. Results were compared with other data in the literature. The sensitivity of the new modified phosphatase assay was also compared with that of the original procedure described in USDA Chemistry Laboratory Guidebook. A higher sensitivity was observed for the method described in this paper. However, the method’s reproducibility was poorer than that of common analytical methods. Although high, the variability may still be acceptable for determining phosphatase activity to assess extent of heat treatment of canned picnics and hams.

Correlation of electrochromic properties and oxidation states in nanocrystalline tungsten trioxide

In nanocrystalline tungsten trioxide, the main coloration change can be attributed to the formation of W⁴⁺.

Characterisation of an OCS-dependent severe asthma population treated with mepolizumab

A subpopulation of patients with asthma treated with maximal inhaled treatments is unable to maintain asthma control and requires additional therapy with oral corticosteroids (OCS); a subset of this population continues to have frequent exacerbations. Alternate treatment options are needed as daily use of OCS is associated with significant systemic adverse effects that affect many body systems and have a direct association with the dose and duration of OCS use. We compared the population demographics, medical conditions and efficacy responses of the OCS-dependent group from the DREAM study of mepolizumab with the group not managed with daily OCS.

TRIAL REGISTRATION NUMBER

NCT01000506.

Das ultraschallaktivierte Skalpell “Ultracision Harmonic Scalpel®”Erste Ergebnisse bei der Chirurgie der Zunge und des weichen Gaumens

The ultrasonically activated scalpel (UAS) performs tissue dissection and coagulation simultaneously by an ultra-high-frequency movement of the blade. In the present prospective study, results of UAS in the surgery of the tongue and the soft palate are analysed. 25 patients with carcinoma of the tongue and 11 patients with carcinoma of the soft palate were examined in regard to intra- and postoperative hemostasis, wound healing and postoperative pain. Also, the quality of the histo-pathological specimen obtained by UAS was evaluated. In 68% (17/25) of partial tongue resections, and in 82% (9/11) of soft palate resections efficient intraoperative hemostasis did not require electrocoagulation or suture ligature. In 32% (8/25) of tongue malignancies, all with extension to the tongue base, and in 18% (2/11) of soft palate resections additional ligation was required because of arterial bleeding from vessels exceeding 1.0 mm in diameter. Wound healing was uneventful in all cases. The histopathological evaluation, especially in the margin area, was not impaired. The UAS offers a tissue dissection with efficacious intra- and postoperative hemostasis. Arterial bleeding from vessels exceeding 1.0 mm in diameter should be sutured additionally. The combination of simultaneous tissue dissection and hemostasis enables a good overall view and control of the surgical situs. In addition, based on the mechanical function the UAS has only little thermical effect on neighbouring tissues and enables a controlled tumor resection without damaging vital structures.

Effect of dietary vitamin E supplementation on the shelf life of cured pork sausage

This study examined the shelf life of cured sausage under different packaging conditions from vitamin E supplemented pigs. One group (n=6) of crossbred pigs received a normal fattening diet containing 20 ppm α-tocopherol for 39 days before slaughter. Another group was fed a diet containing 410 ppm α-tocopherol during the same period. After slaughter, cured sausages were produced, packaged under three different atmospheric conditions, ripened for 4 weeks and then stored for 8 weeks (9 °C; 200 lux). The α-tocopherol content was recorded in the fat, liver, muscles and the sausage. TBARS, L*, a*, b* values and antioxidative capacity were evaluated in the sausage during storage. The results showed a transfer of vitamin E into tissues and sausage but no detectable effect on TBARS and colour stability. However, antioxidative effects of vitamin E were seen by provocation. Probably the effect of vitamin E in the sausage was masked by nitrite in the curing salt. The oxygen content of the packs had an influence on TBARS and colour stability.

U.S. and European severe asthma cohorts: what can they teach us about severe asthma?

Asthma is a global health problem affecting around 300 million patients of all ages and ethnic groups in all countries around the world. In the majority of subjects with persistent, mild-to-moderate asthma (MA), the disease can be relatively well controlled by the use of currently available medications; however, five to ten per cent of patients suffer from a particularly severe disease that is poorly controlled clinically and often refractory to usual treatment. Improved care of severe asthma (SA) is a major unmet medical need and several international consortia aim at improving our understanding of mechanisms in SA. To manage SA better, standardized definitions and concepts of asthma severity, risk and level of control are critical. In the following sections, we present several guidelines approaches and definitions followed by an overview of U.S. (SARP) and European (ENFUMOSA, BIOAIR, U-BIOPRED) SA networks. Key findings regarding SA phenotypes, risk factors and pathophysiology are discussed. International cooperation in the area of respiratory diseases, including SA, across the Atlantic Ocean, will lead to a better understanding of asthma pathology, especially of those severe, not well controlled or difficult-to-treat cases.

Functional analysis of splice site mutations in the human hairless (HR) gene using a minigene assay

BACKGROUND

Congenital atrichia is a rare autosomal recessive form of isolated alopecia which is caused by mutations in the human hairless (HR) gene. Patients are born with normal hair that is shed almost completely and irreversibly during the first weeks of life.

OBJECTIVES

To investigate the molecular genetic basis of congenital atrichia in two patients, and to analyse the functional consequences of one newly identified and all seven previously identified HR splice site mutations using a minigene assay.

METHODS

Molecular analysis of the HR gene was performed by direct DNA sequencing. To analyse the functional consequences of the splice site mutations, the respective sequences were cloned into a vector which allows directed splicing. After transfection of COS7 cells, isolation of RNA and cDNA synthesis, sequencing was performed to analyse the products.

RESULTS

Two novel mutations were identified: an insertion in exon 2 (c.485insT; p.C162LfsX17), and a splice site mutation (c.2847-1G>A). In vitro analysis revealed aberrant splicing for all eight of the investigated HR splice site mutations. Comparison with the results of two biocomputational programs (neural network splice server and CRYP-SKIP) and calculation of consensus values revealed that the predictions of these two programs were consistent in only five and two of the eight mutations, respectively.

CONCLUSIONS

This is the first report to analyse the consequences of HR splice site mutations using a cell-based in vitro assay. The results highlight the importance of performing splicing experiments to clarify the consequences of putative splice site mutations.

Surface sensitivity in scanning transmission x-ray microspectroscopy using secondary electron detection

The successful integration of electron detection into an existing scanning transmission x-ray microspectroscope (STXM) at the Swiss Light Source is demonstrated. In conventional x-ray detection using a photomultiplier, STXM offers mainly bulk sensitivity combined with high lateral resolution. However, by implementation of a channeltron electron multiplier, the surface sensitivity can be established by the detection of secondary electrons emitted from the sample upon resonant excitation. We describe the experimental setup and discuss several relevant aspects, in particular the schemes to correct for self-absorption in the specimen due to back illumination in case of thicker films.

Mechanisms that regulate homing function of progenitor cells in myocardial infarction

Cell based therapy has become a new and attractive option for the treatment of cardiac disease and heart failure. Although it has been demonstrated in vitro and in vivo that differentiation of non-differentiated cells (progenitor cells) into cardiomyocytes is able even in adult hearts the potential use of such transdifferentiation processes is limited by the small number of cells that home and engraft in the myocardium and complete the transdifferentiation process. Therefore, cell recruitment to the damaged heart is a major challenge to improve any cell based therapy. This process requires homing and engraftment of stem or progenitor cells. Major strategies to improve stem or progenitor cell homing are based on an improvement of stem or progenitor cell mobilization from the bone marrow. Strategies that have been shown to be successful are those that use granulocyte colony-stimulating factor (G-CSF). But although cell mobilization was indeed successful no major impact on hemodynamics was found. Alternatives are therefore needed and experimental studies use parathyroid hormone, statins, erythropoietin, and others in addition to or as an alternative to G-CSF. Although each of these procedures does have an impact on cell mobilization and homing none of these studies has provided a direct evidence that a major improvement on top of standard pharmacological therapy can be expected from such strategies. In conclusion, improvement of stem cell homing is a major challenge in the development of successful cell based therapies but not yet improved to a clinical relevant status. The underlying concepts of different strategies will be discussed here.

Integration of human papilloma virus type 26 in laryngeal cancer of a child

Squamous cell carcinoma (SCC) in larynx is rare with children and adolescents. Usually larynx cancer is common with male smokers in the 7th decade. Among patients with no history of tobacco and/or alcohol consumption several factors have can play a role in the outbreak of laryngeal cancer: such as individual predisposition, radiation, gastroesophageal reflux, viral infection, dietary factors and environmental influences. In literature only few cases of laryngeal cancer with children are reported. Recent studies show that the most frequent laryngeal malignancy is the embryonal rhabdomyosarcoma. Besides the recurrent respiratory papillomatosis (RRP) based on an infection with human papilloma virus (HPV) types 6 and 11 (low risk) and types 16 and 18 (high risk) is known for a possible malignant transformation towards a SCC. HPV type 26 is only reported as low risk type HPV associated with cervical cancer. Final diagnosis often takes a long time. Initial symptoms such as hoarseness, cough or shortness of breath are often referred to more typical pediatric diseases or laryngeal development.

Angiotensin II: a hormone involved in and contributing to pro-hypertrophic cardiac networks and target of anti-hypertrophic cross-talks

Angiotensin II (Ang II) plays a major role in the progression of myocardial hypertrophy to heart failure. Inhibiting the angiotensin converting enzyme (ACE) or blockade of the corresponding Ang II receptors is used extensively in clinical practice, but there is scope for refinement of this mode of therapy. This review summarizes the current understanding of the direct effects of Ang II on cardiomyocytes and then focus particularly on interaction of components of the renin-angiotensin system with other hormones and cytokines. New findings described in approximately 400 papers identified in the PubMed database and published during the 2.5 years are discussed in the context of previous relevant literature. The cardiac action of Ang II is influenced by the activity of different isoforms of ACE leading to different amounts of Ang II by comparison with other angiotensinogen-derived peptides. The effect of Ang II is mediated by at least two different AT receptors that are differentially expressed in cardiomyocytes from neonatal, adult and failing hearts. The intracellular effects of Ang II are influenced by nitric oxide (NO)/cGMP-dependent cross talk and are mediated by the release of autocrine factors, such as transforming growth factor (TGF)-beta1 and interleukin (IL)-6. Besides interactions with cytokines, Ang II is involved in systemic networks including aldosterone, parathyroid hormone and adrenomedullin, which have their own effects on cardiomyocytes that modify, amplify or antagonize the primary effect of Ang II. Finally, hyperinsulemia and hyperglycaemia influence Ang II-dependent processes in diabetes and its cardiac sequelae.

[Efficacy and longterm compliance of the vest preventing the supine position in patients with obstructive sleep apnea]

BACKGROUND

Treating the positional obstructive sleep apnea with a vest preventing the supine position is well known to be riskless and inexpensive. It was the aim of this study to test the efficacy and, for the first time, the longterm compliance of this treatment.

METHODS

14 patients with positional obstructive sleep apnea (age 48.2 +/- 12.1 years; body-mass-index: 28.1 +/- 4.6 kg/m2 mean, +/- SD) were investigated polysomnographically without and with a vest preventing the supine position. 13.7 +/- 15.9 months later the patients were asked about the comfort of the vest and the nocturnal using time using the Likert-scale, and data about the latest Epworth Sleepiness Scale (ESS) was collected.

RESULTS

The respiratory disturbance index (RDI) was reduced statistically significant from 31.3 +/- 12.9/h to 13.8 +/- 9.0/h by wearing the vest (p < 0.001). Total sleep time at an oxygen saturation below 90% decreased from 8.2 +/- 7.1% to 3.8 +/- 4.5% (p < 0.001), the snoring time from 15.4 +/-19.6 % to 9.8 +/-13.1% (p < 0.05) of the total sleep time (TST) and the arousal index from 23.1 +/-16.0/h to 18.6 +/-11.4/h (p < 0.05). 24 +/-28.8 months later 28.6% of the patients were still using the vest. Of these patients the ESS decreased from 8.5 +/-3.2 to 6.5 +/-2.9 (p < 0.05). 72.4% of the patients refused the longterm therapy with the vest because of its low wearing comfort.

CONCLUSIONS

Although the vest approved to be effective against positional obstructive sleep apnea, the longterm compliance is low because of its need getting used to.

Clinical relevance of airway remodelling in airway diseases

Asthma and chronic obstructive pulmonary disease (COPD) are characterised by airflow obstruction, airway remodelling (measurable structural change) and inflammation. The present review will examine the relationship between airway remodelling in these two conditions with respect to symptoms, abnormal lung function, airway hyperresponsiveness and decline in lung function. The potential for remodelling to be a protective response will also be discussed. Asthma is associated with variable symptoms and changes in lung function and also fixed abnormalities of lung function and an increased rate of decline in lung function with age. There is a relative preservation of the relaxed airway lumen dimensions, prominent thickening of the smooth muscle layer and reduced airway distensibility. The severity of asthma is related to the degree of airway remodelling, which is most marked in cases of fatal asthma. In COPD, symptoms are persistent and predictable but also progressive and are related to fixed abnormalities of lung function. Remodelling is associated with narrowing of the airway lumen and an increased thickness of the airway wall, although not usually to the extent seen in asthma. COPD is most often due to smoking where there is also remodelling of the parenchyma that may contribute to symptoms.

[Diagnosis and clinical therapy for Parkinson's disease]

For decades, awareness of Parkinson's disease mainly focused on the presence and treatment of motor symptoms. More and more other symptoms of this disease not related to the motor system now receive increased attention, including cognitive decline. Dementia in Parkinson's disease occurs more often than initially was thought. After an average of 8 years, about 40% of these patients suffer from cognitive decline. The difficulties and related problems affect prognosis more than do the motor symptoms. There is a need for standardized diagnostic and specific therapeutic intervention, but appropriate studies are still lacking.

Die Wertigkeit der Computertomographie des Thorax im Rahmen des Stagings von fortgeschrittenen Kopf-Hals-Malignomen

AIM

At time of diagnosis, up to 17 % of HNSCC present with distant metastasis or a second primary tumour. Distant metastases of these tumours most commonly occur in the lung, requiring a particularly precise evaluation of this organ within the staging process. It was the aim of this study to compare the radiological findings of plain chest X-rays with the results of CT-scans of the chest in regard to their sensitivity for metastasis detection.

PATIENTS AND METHODS

The staging examinations of 47 patients (f: 13, m: 34, mean age: 61.6 y) with progressed (T3, T4, N+) or recurrent HNSCC were prospectively analysed and results of chest X-rays as well as CT-scans of the chest compared.

RESULTS

Only one plain chest X-ray showed a possible metastasis, which was excluded by the following CT-scan. In none of the other 46 patients did X-ray reveal findings of metastatic disease or second primary tumours. CT-scans of the chest showed tumorous lesions in 8/47 (17 %) patients. Three of these tumours were confirmed as neoplastic by biopsy, in another case radiological signs and clinical symptoms permitted definite assumption of malignancy (4/47 : 8.5 %). Histologically, only one of the latter four tumours could be identified as metastatic. In the remaining three cases we found second primary tumours. A follow up CT-scan of one of the remaining four cases showed normal results. In 3 cases the aetiology of the CT-findings remained unclear.

CONCLUSION

Cervical lymph node metastases, tumour-size and recurrence of HNSCC are known risk factors for metastatic disease in HNSCC. Chest X-ray as staging procedure in patients with progressed or recurrent HNSCC may not be able to identify metastases or a second primary tumour of the lung. We therefore recommend a CT-scan of the chest as a routine procedure in such patients to optimise the pre-operative staging.

[Relapsing polychondritis -- a case report and review of the literature]

PATIENT

A case of a 54-year-old woman with a three month history of recurrent bilateral chondritis of the auricles, cochlear and vestibular inner ear damage and conjunctivitis is described. The diagnosis was based only on clinical criteria (auricular chondritis, conjunctivitis, inner ear damage). Antinuclear antibodies, ANCA and HLA-DR 4 antigen were negative. The only laboratory abnormality was an elevated erythrocyte sedimentation rate. The patient has been treated successfully with Methotrexate 20 mg 1 x /week and Prednisone 15 mg/die for 4 month now.

DISCUSSION

The relapsing polychondritis (RP) is a rare, multisystemic and potentially fatal disease. The pathogenesis and optimal therapeutic approach is poorly understood. The disease is characterized by episodic inflammation of cartilage such as auricular, nasal and laryngotracheal. Many other proteoglycan-rich structures like inner ear, eye, kidney and blood vessels, may be involved as well. RP has an equal sex prevalence. The majority of cases appear between 40 and 60 years. Auricular inflammation is the most common feature. Effectiveness of non-steroidal anti-inflammatory drugs, dapsone, immunosuppressive drugs and prednisone has been described. The overall survival rates were 74 % at 5 years and 55 % at 10 in one 1986 series.

CONCLUSION

The most common clinical presentation of RP regularly involves ENT-structures. Therefore ENT-specialists should be familiar with this disease. A close interdisciplinary cooperation is essential for therapy and follow-up, because pulmonary and cardiac involvement are limiting prognostic factors.

[Life-threatening complications after plastic tracheostomy closure. Which length of hospital stay according to clinical and forensic viewpoints is necessary?]

BACKGROUND

Plastic tracheostomy closure represents a safe surgical method with rare but potentially life-threatening complications such as dyspnea. Because of the general tendency to reduce hospital stay, the medically necessary time of hospitalization should be evaluated.

METHODS

Ninety-eight patients operated in succession were examined retrospectively for extent, time, and therapeutic procedures in cases of life-threatening dyspnea. Moreover, disorders of wound healing which had to be treated surgically were analyzed.

RESULTS

Of 98 patients 17% (17/98) developed dyspneas, 10% (10/98) up to the 3rd postoperative day, 2% (2/98) on the 6th postoperative day, and 5% (5/98) between the 17th and 92nd postoperative days; 13% (13/98) had to be treated because of extensive disorders of wound healing, 85% (11/13) up to the 3rd day.

CONCLUSION

From the clinical and forensic viewpoint, a hospital stay for at least 3 postoperative days is necessary to record the majority of life-threatening complications after plastic tracheostomy closure.

The effect of treatment with omalizumab, an anti-IgE antibody, on asthma exacerbations and emergency medical visits in patients with severe persistent asthma

BACKGROUND

Patients with severe persistent asthma who are inadequately controlled despite treatment according to current asthma management guidelines have a significant unmet medical need. Such patients are at high risk of serious exacerbations and asthma-related mortality.

METHODS

Here, we pooled data from seven studies to determine the effect of omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, on asthma exacerbations in patients with severe persistent asthma. Omalizumab was added to current asthma therapy and compared with placebo (in five double-blind studies) or with current asthma therapy alone (in two open-label studies). The studies included 4308 patients (2511 treated with omalizumab), 93% of whom had severe persistent asthma according to the Global Initiative for Asthma (GINA) 2002 classification. Using the Poisson regression model, results were calculated as the ratio of treatment effect (omalizumab : control) on the standardized exacerbation rate per year.

RESULTS

Omalizumab significantly reduced the rate of asthma exacerbations by 38% (P < 0.0001 vs control) and the rate of total emergency visits by 47% (P < 0.0001 vs control). Analysis of demographic subgroups showed that the efficacy of omalizumab on asthma exacerbations was unaffected by patient age, gender, baseline serum IgE (split by median) or by 2- or 4-weekly dosing schedule, although benefit in absolute terms appeared to be greatest in patients with more severe asthma, defined by a lower value of percentage predicted forced expiratory volume in 1 s (FEV(1)) at baseline.

CONCLUSIONS

These results suggest that omalizumab may fulfil an important need in patients with severe persistent asthma, many of whom are not adequately controlled on current therapy.

[Course and therapy of an invasive aspergilloma of the skull base in a non-immunocompromised patient]

Fulminant-invasive sinus aspergillosis affects immunocompromised patients and is usually lethal because of intracranial complications. Chronic-invasive and non-invasive types occur in non-immunocompromised patients. In these cases, intracranial extension is possible and life-threatening. The effective management of sinus aspergillosis requires early diagnosis by CT and histological classification, surgery, and if necessary, chemotherapy or steroids in case of allergy. Here we report a successfully treated case in a 29-year-old non-immunocompromised patient with chronic-invasive sinus aspergillosis. He presented a recurrent sphenoid sinus aspergillosis with destruction of the clivus and ophthalmoplegia. Diagnostic and therapeutic procedures are described.

[Stability of voriconazole in infusion bags]

Stability of voriconazole in infusion bags The dosage of i.v. administered voriconazole in adults and children is body weight based. For this reason an individual preparation is necessary in those patients. Further stability data were needed for a central production in the hospital pharmacy department, however. Three concentrates and three bags were produced (day 1) according to the procedures given by the product leaflet. Our data shows that the ready to use bag and the concentrate solution is stable at 2-8 degrees C for 32 days.

Reduktion akuter radiogener Schädigungen durch Natriumselenit

BACKGROUND

In vitro studies show that sodium selenite is a potential radioprotector in normal cell cultures, but not tumor cells. The aim of this study was to evaluate the cytoprotective potency of sodium selenite during conventional fractionated irradiation of rat salivary glands, but also on tumor response and metastasis frequency of rhabdomyosarcomas R1H.

METHOD

The head-neck area of male WAG/RijH rats and the tumor in the flank were irradiated with (60)Co-gamma-rays (60 Gy/30 fractions/6 weeks). Sodium selenite (15 microg/kg body weight) was applied through a venous port 30 min before irradiation. Rats of a control group were treated in the same manner with an equal volume of physiologic sodium chloride. In the course of treatment the salivary glands were extirpated at different stages and examined histopathologically. The evaluation of the gland function was performed prior to and after radiotherapy by sialoscintigraphy. Tumor volume was measured during irradiation and plotted in tumor-volume curves. Rat body weight was determined sequentially to estimate the general constitution of the animal during the treatment.

RESULTS

Irradiation caused dose-dependent damage in the salivary glands. Intra- and intercellular edema (16 Gy), vacuolization (30 Gy), degranulation (46 Gy), and necrosis of the acinar cells (60 Gy) occurred. Sodium selenite delayed the development of the described damage, and the amount of necrotic acinar cells after the application of 60 Gy was reduced (control: 75% vs sodium selenite 30%), confirmed by the sialoscintigraphic results. The loss in gland function in the control group was 44% vs 74% (p<0.05) in the sodium selenite group. Sodium selenite had no influence on the response of R1H tumors to radiation and general constitution.

CONCLUSIONS

Based on morphological and sialoscintigraphic findings, a cytoprotective effect on acute toxicity of rat salivary glands could be detected under irradiation with synchronous application of sodium selenite. In addition, no effects on tumor response and metastasis frequency were observed. The general animal constitution was not affected by additional medication with sodium selenite during irradiation.

[Squamous cell carcinomas of the upper aerodigestive tract. Prognostic significance of the capsular rupture and extracapsular spread of lymph node metastases]

The capsular rupture and subsequent extranodal spread of lymph node metastases is of crucial and well established prognostic value in patients with squamous cell carcinomas of the upper aerodigestive tract. Besides the basic histologic definition of the extranodal spread (i.e. contact of the metastasis with perinodal fatty tissue), there is no agreement on the morphologic extent of transcapsular spread. As a measure of improvement, a histologic evaluation differentiating between seven gradual types of metastatic nodal affection was applied. The histologic scheme considers intranodal growth, infiltration of the capsule, the presence of desmoplasia and especially the rupture of the capsule and the subsequent extranodal spread of the metastasis. As extranodal spread is an easily reproducible and reliably significant prognostic criterion, it should be included in the current TNM classification, e.g., by an addition of the index R+ (lymph node metastasis with capsular rupture) or R- (lymph node metastasis without capsular rupture) to the N category.