[Antineoplastic effectiveness and unwanted side effects of polychemotherapy of extensive oro- and hypopharyngeal cancers--results of a prospective therapy study with 5-FU/cisplatin versus 5-FU/carboplatin]

60 patients with advanced carcinomas of the oropharynx and hypopharynx underwent chemotherapy, either with 5-FU/Cisplatin (n = 30) or with 5-FU/Carboplatin (n = 30). The remission-rates (complete and partial remissions) were comparable in both groups. The rate of complete remissions, however, was statistically significant higher in the cisplatinum group (6 patients) than in the carboplatinum group (1 patient). 2 patients of the 5-FU/Cis-group and 4 patients of the 5-FU/Carbo-group developed a progressive disease during chemotherapy. Statistically significant differences were found in the nephrotoxic and myelotoxic side effects between both therapy groups: nephrotoxic side effects were more frequent in the 5-FU/Cis-group, whereas myelotoxic side effects occurred mainly in the 5-FU/Carbo-group. The chemotherapy with 5-FU/Carboplatin was better tolerated by the patients than in the 5-FU/Cisplatinum-group. In the 5-FU/Carbo-group especially a lower rate and severity of loss in weight, nausea, vomiting, alopecia and mucositis/stomatitis was observed. No statistically significant differences were found in ototoxic side effects between both groups.

[A new implant system in head and neck surgery]

Defects in the head and neck region following extensive tumor removal are sometimes difficult to reconstruct by local or free flaps. An epithesis is a recommended alternative in defects of the ear, the nose or the orbital region. Nevertheless problems may arise in the appropriate fixation of the epithesis. With the intermobile-cylinder-implant-system (IMZ), the epithesis is firmly fixed by means of osseointegration of the implants and an abutment in the area of the defect. The various steps of the operation and clinical applications are presented.

[Regional lymph node metastases in malignant tumors of the head and neck: value of diagnostic procedures]

Sonography and computed tomography are used in staging of lymph nodes of patients with head and neck cancer. The accuracy of sonography (90%) and computed tomography (85%) is comparable or better than the palpatory accuracy (85%). The better delineation of reactive swollen cervical nodes leads to a higher sensitivity of sonography (90%) and computed tomography (84%) versus palpation (74%), but a lower specifity (palpation 94%, sonography 90%, computed tomography 86%). A literature survey shows that sonography, computed tomography and magnetic resonance imaging of cervical lymph nodes are comparable good methods.

[Cervical lymph node metastases: a histologically controlled comparison of palpation, sonography and computed tomography]

Sonography and CT were used pre-operatively for lymph node staging in patients with head and neck malignancies. The accuracy of the imaging methods surpassed that of palpation (palpation 85%, CT 85%, sonography 90%). Sensitivity was significantly increased from 74% (palpation) to 84% (CT) and 90% (sonography), ie. there was a reduction in false negative findings. Size of lymph nodes was not closely correlated with metastatic involvement. Reactively enlarged lymph nodes were more easily defined by CT and sonography than by palpation. This reduced the specificity of sonography (90%) and of CT (86%) compared to palpation (94%).

[Compression pneumatocele of the lacrimal sac]

Case report on a 39-year-old man who for five years suffered from a recurrent, firm, crepitant swelling in the medial canthal region after coughing and sneezing. The swelling could be eliminated by digital compression. During a severe bout of sneezing a walnut-sized swelling suddenly occurred which could not be eliminated by compression. Echographic and intraoperative findings confirmed the diagnosis of a large, diverticulous pneumatocele that had compressed the lacrimal sac to such an extent that the entrapped air could not escape. Endoscopy of the nose revealed a wide nasolacrimal ostium, without a Hasner's valve. It was thus possible for air to flow back into the lacrimal drainage system from the nasal cavity.

[Palpation and sonography of lymph node metastasis of the neck]

In a retrospective study, the diagnostic value and ranking of preoperative palpation and sonography for the identification of cervical lymph nodes was assessed in 130 patients with tumours of the head and neck. The diagnostic accuracy (85%) of palpation is below that of sonography (90%). The importance of sonography lies in reducing false negative findings. The increase in sensitivity (palpation 74%, sonography 90%) is, however, offset by an increase in false positive findings, i.e. by a reduction in specificity (palpation 94%, sonography 90%).

[Differential echographic diagnosis of salivary gland tumors]

76 patients with tumorous swellings of the salivary glands were examined by means of standardized A-scan and B-scan sonography. B-scan echography allowed a differentiation between benign and malignant tumours in all cases. Analysis of the various A-scan criteria (internal structure, reflectivity, borders, consistency and sound attenuation) provided a pathognomonic combination of these criteria for each lesion, enabling further histological diagnosis.

Variations in human corpus callosum do not predict gender: a study using magnetic resonance imaging

Controversy exists in the neuropsychological literature concerning the existence of gender-associated differences in cognitive functioning and in hemispheric lateralization of cognitive functions. A recent study, based on 14 brains obtained at autopsy, reported sex differences in the splenium of the human corpus callosum and suggested that the larger splenium in females reflects less hemispheric lateralization, or "specialization," than the male brain for visuospatial functions. Our measurements of the human corpus callosum using magnetic resonance images of 37 living subjects failed to confirm reported sex differences in the splenium. A marginally significant sex-related difference in minimum body width and an age-related decrease in anteroposterior distance were found. Most striking were the large variations in callosal size and shape among individuals regardless of age or gender. Existing knowledge of the functions of the corpus callosum does not permit correlations between variations in callosal size and shape and variations in cognitive functions.

Variations in human corpus callosum do not predict gender: A study using magnetic resonance imaging

Controversy exists in the neuropsychological literature concerning the existence of gender-associated differences in cognitive functioning and in hemispheric lateralization of cognitive functions. A recent study, based on 14 brains obtained at autopsy, reported sex differences in the splenium of the human corpus callosum and suggested that the larger splenium in females reflects less hemispheric lateralization, or "specialization," than the male brain for visuospatial functions. Our measurements of the human corpus callosum using magnetic resonance images of 37 living subjects failed to confirm reported sex differences in the splenium. A marginally significant sex-related difference in minimum body width and an age-related decrease in anteroposterior distance were found. Most striking were the large variations in callosal size and shape among individuals regardless of age or gender. Existing knowledge of the functions of the corpus callosum does not permit correlations between variations in callosal size and shape and variations in cognitive functions.

[Echographic diagnosis in tumors of the paranasal sinuses with invasion of the lacrimal ducts]

In 16 patients the histologically proven diagnosis of a lacrimal sac tumor was made; in 9 of them a paranasal sinus tumor had invaded the lacrimal pathways, in 7 patients existed a primary tumor of the lacrimal sac, A- and B-scan sonography allow a clear-cut differentiation of both these entities. Furthermore primary and tumor-related inflammations of the lacrimal pathways can be distinguished by echography, which thereby provides the decisive diagnostic basis for the different therapeutic procedures in each case.

Medial preoptic sexual dimorphisms in the guinea pig. I. An investigation of their hormonal dependence

The guinea pig exhibits sexually dimorphic patterns of cell density and distribution throughout the medial preoptic area, a region that has been shown to be involved in the regulation of sexually differentiated behavioral and endocrinological reproductive functions (Bleier et al., 1982). The most prominent sex differences involve 2 components of the medial preoptic nucleus (MPN), an anteriorly placed compact subnucleus (MPNa) that is twice as large in females as in males, and a centrally placed compact subnucleus that occupies an approximately 10-fold greater volume in males than in females and corresponds to the sexually dimorphic nucleus described in the rat by Gorski et al. (1978). In the present study the sex differences in both of these cell groups were shown to be unaffected by neonatal gonadectomy and postnatal hormonal manipulations. In contrast, MPNa volume was significantly decreased and MPNc volume significantly increased in genotypic females exposed to testosterone propionate (TP) on gestational days 28-37 or 28-65 but not 38-65. All 3 prenatal TP treatments administered to females significantly increased mounting frequencies and suppressed lordosis, ovulation, and the positive-feedback effects of estrogen and progesterone on luteinizing hormone release. Thus, the volumetric sex differences in MPNa and MPNc alone do not seem to be sufficient to account for the sex differences in the functions of the medial preoptic region. It is, therefore, suggested that androgens continue to exert organizational influences upon the developing brain after cytoarchitectonic patterns have been determined.

[Bacteriological, clinical, and pharmacokinetic studies of perioperative antibiotic prophylaxis in head and neck surgery]

The point of this study was to analyze the possible benefits of perioperative antibiotic prophylaxis in patients from whom oral cavity or throat tumors are removed. The criteria used to judge the efficacy of each treatment included the clinical course of the treatment, the bacterial colonization of the surgical area as well as the growth of bacteria during the postoperative phase. 50 patients were chosen and grouped according to their surgical treatment: laryngectomy (n = 20), partial laryngectomy (n = 22) or tongue, floor of the mouth, soft palate, gum or base of the tongue partial resection (n = 8). Within each surgical group, patients were randomly chosen for antibiotic prophylaxis; others constituted the untreated control group. The antibiotic prophylaxis consisted of 5 g Mezlocillin administered at the time of narcosis for 20 min followed by 0.5 g Metronidazol for 10 min. These medications were given in 8-hour intervals for three days following surgery. Investigation of the first 20 patients (prophylaxis group n = 7, control group n = 13) revealed that the combination of Mezlocillin and Metronidazol positively influenced post-operative recovery (no complications) while the patients without prophylactic antibiotic treatment suffered general or local complication leading to, in 10 cases, the necessity of postoperative therapy. On the basis of these results, the random grouping of the patients was ended and all 30 remaining patients were given the antibiotic prophylaxis. Regardless of antibiotic treatment, the great majority of microbes isolated from throat swabs and tracheal secretions were gram-negative, aerobic bacteria. A prerequisite for efficacious prophylaxis is that the antibiotics be applied before the operation, so that a sufficient concentration is present at the time of pharyngotomy. On the basis of pharmacokinetic investigations, administration of the antibiotic 30 min preoperatively fulfills this requirement. Further, our recommendation, based on our measurement of the spectrum of bacteria present and their growth is that the antibiotics be applied over a period of three days postoperatively. This recommendation is also based on the fact that some patients (those having undergone partial laryngectomy or tongue, floor of the mouth, base of the tongue partial resections) have suffered loss of the swallowing reflex so that there exists a continuous contamination of the surgical area with pathogens or facultative pathogens coming from the nasal or oral cavities.

Intraventricular neuronal complex of the lamina terminalis of the mouse

An intraventricular neuronal complex has been identified with scanning and transmission electron microscopy at the base of the lamina terminalis of the mouse. The raspberry-shaped complex protrudes from a thickened bulge on the ependymal surface of the lamina terminalis or adjacent rostral floor of the third ventricle. Neurons and occasional ependymal cells cover the surface of the complex. Its core is made up of neurons, ependymal cells, and neuronal processes, which are usually compactly arranged. The core is continuous, through a breach in the ependymal layers, with the subependymal neuropil of the lamina terminalis. Within the core of the complex are large numbers of axodendritic synapses. Axonal varicosities and synaptic terminals are filled with vesicles and mitochondria. Synaptic endings have one of two populations of vesicles: exclusively clear, small, round or flattened vesicles. In view of the known structural and functional characteristics of the lamina terminalis, it is possible that the neuronal complex may participate in neurohormonal regulatory systems of the hypothalamus and hypophysis or in the network of circumventricular organs mediating angiotensin effects.

[Echographic diagnosis in injuries of the paranasal sinuses]

A-scan and B-scan sonography was performed in 86 patients with fractures in the paranasal region (73 blow-out, 8 ethmoidal, 5 frontal sinus fractures). In all of them echography provided a correct diagnosis by delineating fracture lines and bone fragment dislocation. Additionally, sonography detected a haematosinus in 17, and a subperiosteal haematoma in 6 patients, respectively. Although echography can never replace radiologic diagnostics, it should be performed in the primary evaluation and in the follow-up of all patients with paranasal traumatology because of its high accuracy.

[Echographic diagnosis in orbital mucoceles]

Sonography in 68 patients with orbital mucoceles revealed the following, pathognomonical A-scan criteria: Regular structure, low to extremely low reflectivity, sharply outlined borders, bony defects, missing or minimal compressibility and typical location in the supero-nasal anterior orbit. The echographical findings of "mucoceles" secondary to paranasal tumours are specially emphasised. Echography proves to be a very useful method in the detection and differentiation of orbital complications in paranasal diseases.

[Echographic diagnosis of the ethmoid sinus. I: General principles, experimental studies, study technic and normal findings]

A technique for the echographical examination of the ethmoidal sinus is presented. Experimental and clinical investigations have shown that the medium and even the posterior part of the ethmoid can be examined, if the probe is placed on the anesthesized conjunctiva of the lateral part of the palpebral fissure. Experimental and normal findings are demonstrated and discussed.

[Echographic diagnosis of the ethmoid sinus. II: Clinical findings]

We report on our first clinical results of the echographical examination in ethmoidal diseases using the transocular sound beam direction, and present the A- and B-scan findings in ethmoidal inflammation, mucoceles and tumours. If bony defects in the medical orbital wall and orbital involvement are present, standardized A-scan sonography enables us not only to detect, localise and measure, but also to differentiate various ethmoidal tumours.

Cytoarchitectonic sexual dimorphisms of the medial preoptic and anterior hypothalamic areas in guinea pig, rat, hamster, and mouse

A cytoarchitectonic analysis is presented of a configuration of cells which extends through the medial preoptic and rostral part of the anterior hypothalamus of the guinea pig, rat, hamster, and mouse. Within that configuration, called here the sexually dimorphic nuclear complex of the medial preoptic-anterior hypothalamic area (SDNC-MPAH), there is nearly continuous variation in cellular distribution or packing density as one proceeds rostrocaudally, as well as variations between females and males at corresponding levels. The major cell groups comprising SDNC-MPAH are the medial preoptic nucleus (MP) and the preventricular portion of the periventricular nucleus (Pep) rostrally, and the anterior hypothalamic nucleus (AH), anterior portion of periventricular nucleus, (Pea), and bed nucleus of stria terminalis (ST) caudally. The most striking cytoarchitectonic dimorphisms usually involve MP and AH. In all four species examined, MP is larger and, except for the mouse, appears to be more densely cellular in the female than in the male. Most prominently in the rat and guinea pig, AH is densely cellular throughout in the female, including the subependymal zone, whereas in the male AH lies at a distance from the third ventricle, separated from the ependyma by a cell-poor zone. The significance of these findings may lie in the fact that the region exhibiting the sexual dimorphisms has been shown to be involved in the regulation of reproductive functions which are sexually differentiated and developmentally influenced by the fetal or perinatal hormonal milieu in some species.

Macrophages of hypothalamic third ventricle. I. Functional characterization of supraependymal cells in situ

Cells on the ependymal surface of hypothalamic third ventricle of hamsters exhibit surface, ultrastructural, and phagocytic features of macrophages. The object of this investigation was to identify functions that a resident phagocytic system of the ventricles of the brain may have normally. We found that supraependymal macrophages in two- to three-week-old hamsters were associated with intact and degenerating intraventricular neuronal processes, ependymal cytoplasmic blebs, and degenerating intraventricular cells. These macrophages frequently contained cellular debris within phagosomal vacuoles. In the vicinity of neuronal ganglion on the floor of the third ventricle, there were numerous structures identified as growth cones, with organelles in varying stages of alteration and degeneration. Supraependymal macrophages apparently remove cellular debris resulting from ependymal metabolic processes and from cellular and neuritic degeneration. Such activity may be part of a normal process of remodeling, involving cell growth, renewal, or cell death within the third ventricle of developing animals.

Macrophages of hypothalamic third ventricle. II. Immunological characterization of supraependymal cells in culture

The question of whether hematogenous macrophages are present in the brain has remained incompletely resolved for many years. In the present study, a modified tissue culture system was employed, which enabled the isolation and visualization of cells which migrated from the surface of the hypothalamic third ventricle. Cultured cells were examined for macrophage characteristics, such as surface fine structure and cell spreading, phagocytic activity, nonspecific esterase activity, and the presence of cell surface receptors for the Fc portion of the immunoglobulin IgG. Markers of these characteristics were correlated cell by cell with light microscopy and scanning electron microscopy, utilizing both secondary and back-scattered electron imaging. Cells with all characteristic markers of the monocyte/macrophage line were identified and represent ventricular macrophages.

Supraependymal macrophages of third ventricle of hamster: morphological, functional and histochemical characterization in situ and in culture

Supraependymal cells (SECs) of the young hamster's third ventricle have been examined by scanning and transmission electron microscopy. Of special interest were cells with the surface morphology and ultrastructure of macrophages, which were found in largest numbers in 12--15-day-old females and males. In the ciliated areas SECs are generally smooth and rounded; in nonciliated areas, they frequently have surface ruffles, blebs and microprocesses. SECs were frequently seen to be dividing or fusing. The macrophage-like cells are characterized by prominent Golgi zones and numerous large vacuoles, and frequently contain inclusions in their cytoplasm which resemble intraventricular cell processes, cytoplasmic protrusions from ependymal cells and cellular debris. We have demonstrated that supraependymal macrophage-like cells phagocytose latex beads injected into the ventricles of the brain. Supraependymal cells from 12-day-old hamsters were grown in tissue culture. Phagocytic, cytochemical and surface ultrastructural studies were then done sequentially on the same population of cells. These studies revealed the cells to be actively phagocytic as well as strongly esterase positive and peroxidase negative, consistent with their classification in the macrophage/monocyte category. The surface ruffles, ridges and microprocesses were also characteristic of the SECs seen in situ with scanning electron microscopy and of the macrophages cultured from the peritoneum and peripheral blood of the same hamsters. On the basis of cellular morphology, cytochemical staining characteristics and functional response to exposure to foreign particles both in situ and in cell culture, we have demonstrated that supraependymal cells of the third ventricle of the hamster are phagocytes that resemble cells of the macrophage/monocyte line. It is suggested that they constitute a resident macrophage system of the ventricles of the brain.

A cytoarchitectonic atlas of the mouse hypothalamus

A description of the organization, areas, and cell groups within the hypothalamus of the mouse is presented in detail. Photomicrographs of cell-stained serial sections through the hypothalamus in frontal, sagittal and horizontal planes are included. The hypothalamus has been divided basically into medial and lateral parts with most well-defined cell groups or nuclei lying within the medial subdivision and surrounded by diffuse collections of cells referred to as areas. The heterogenetiy of cell types within most hypothalamic nuclei and areas has been emphasized with the consequent implications for heterogeneity of neuronal connections and of functions. Recently introduced neuroanatomical techniques permitting increased attention to the cellular level of organization have demonstrated precise connections and functional localization of cells within the hypothalamus. While cytoarchitectonic distinctions imply functional distinctions, morphological and experimental evidence suggest the existence also of systems of cells which transcend conventional cytoarchitectonic boundaries, the cells within each system being interconnected functionally or neuronally.

Supraependymal cells of hypothalamic third ventricle: identification as resident phagocytes of the brain

Cells lying on the ventricular surface of the hypothalamic ependyma of the tegu lizard exhibit the pseudopodial and flaplike processes characteristic of macrophages found elsewhere. Since they ingest latex beads, they may be considered a resident phagocytic system of the brain. The importance of ependyma and ventricular phagocytes as a first line of defense against viral invasion of the brain, as well as their role in the pathogenesis of certain virus-related diseases, is suggested by a number of experimental and clinical observations.

Surface fine structure of supraependymal elements and ependyma of hypothalamic third ventricle of mouse

The ependymal surface of the hypothalamic third ventricle of the adult female and male mouse was examined with the scanning electron microscope. The material was dried with the critical point method. Supraependymal cells, exhibiting a variety of forms, lie among the cilia of the rostrodorsal two-thirds of the ventricle. The cell bodies are usually between 8 and 10 mu in diameter and have dividing pseudopodial processes which may be broad or narrow, flat or stout, smooth or varicosed. The textured surfaces of the cells seen in this material appear to have no cilia, microvilli or membraneous folds though they may have small bleb-like protrusions. Some cells and adjacent cilia bear clusters of friable-looking material that may be secretory. In several female mice, mounds of debris, that could be degenerating cells or secretory material, were seen in intimate association with clusters of cells. The cells' processes extend over and through the surface of the mound. While some supraependymal cells may be neurons or glia, it is suggested that many of the cells seen may be morphological variants of one cell line, mononuclear phagocytes. Sausage-shaped structures at the end of long cilia-like stalks are described and their possible identity discussed.