Laryngopharyngeal reflux (LPR) is generally treated with twice-daily proton-pump inhibitor (PPI) therapy. In this study, the efficacy of esomeprazole 40 mg once-daily together with lifestyle modifications was determined by repeated 24-hour pH monitoring.A prospective study. Forty-nine patients with suspected LPR underwent 24-hour pH monitoring. Twenty-seven of 49 patients with measurable abnormal proximal reflux reflected by a reflux area index (RAI)>6.3 were treated with esomeprazole 40 mg every day, and a second pH study was performed.In 22 of 27 patients, everyday PPI treatment reduced the RAI. Four of 5 patients with no RAI reduction reported on symptomatic relief.In a considerable number of patients with suspected LPR, pH monitoring reveals no abnormal proximal reflux. Esomeprazole 40 mg every day together with lifestyle modifications could reach adequate acid suppression in a large number of patients. Symptom improvement is also reported by patients without measurable effects of therapy.
Im vorliegenden Bericht wird eine „Standortbestimmung” von Bedeutung und Wertigkeit der Basalmembran (BM) für das Wachstum benigner und maligner Tumoren, insbesondere des Kopf-/Halsbereiches, gegeben. Die BM stellt dabei eine entscheidende Schranke für Epithelzellen dar, die im Rahmen eines malignen Tumorwachstums durchbrochen werden muß. Wie neue immunhistochemische Untersuchungen zeigen konnten, kommt es nach einer malignen Epitheltransformation zu qualitativen und quantitativen Änderungen der BM-Zusammensetzung, die die Tumorinvasion erst ermöglicht. Der Nachweis solcher Veränderungen stellt aber andererseits auch eine frühe Diagnostik eines solchen Wachstumsverhaltens in Aussicht. Plattenepithel-Karzinome des Kopf-/Halsbereiches zeigen eine Korrelation zwischen dem Ausmaß an erhaltener BM-Expression und dem Grad an Tumordifferenzierung, die möglicherweise auch prognostische Wertigkeit besitzen könnte.
Patients with polyposis nasi have a high recurrence rate and, in more frequent relapse surgeries, also increased postoperative complications. Alternative surgical methods such as paranasal sinus stents can reduce the rate of recurrence and postoperative side effects and shorten the duration of surgery.
Wir berichten über einen 4-jährigen Jungen, der seit Januar 2003 über Dysphagie, eine Schwellung rechts zervikal und über blutigen Auswurf klagte. Unter verschiedenen konservativen Therapieversuchen eines vermuteten Infektes war es zur Beschwerdeprogredienz gekommen. So musste im Februar wegen zunehmender Dyspnoe eine Notfall-Tracheostomie durchgeführt werden. In einer Kernspintomographie zeigte sich nun eine große infiltrierende Raumforderung im Larynx und Hypopharynx rechtsbetont mit V.a. N3-Filia rechts zervikal.
Due to the high recurrence rates of squamous cell carcinoma of the head and neck (SCCHN) and de-novo local secondary carcinomas, a close monitoring of patients is mandatory. In doubtful cases, a clearance by histological biopsy is necessary. This, however, bears potential complications. We analyzed the application of combined cytology and immunocytology in cytological brush smears for diagnosing pre-malignant and malignant lesions of the oral/oropharyngeal cavity.Brush biopsies of 30 subsequently histologically-confirmed oral/oropharyngo-/laryngeal cavity cancer cases (all then in a recurrence status) and normal mucosa were obtained for routine cytology and immunocytology for cytokeratin-8 (CK-8). Additionally 20 samples with inflammatory lesions were investigated.Our results showed a high rate for positive prediction of oral/oropharyngo-/laryngeal dysplasia/cancer cases. Accordingly, 82% of all subsequently confirmed cases were detected by cytology alone (sensitivity). The specificity, however, of cytology was distinctly lower since several doubtful cases contained only inflammatory lesions (specificity 85%). The addition of CK-8-immunocytology did not increase the sensitivity, since the rate of detected cases by immunocytology was comparable to routine cytology (79%); however, the addition of immunocytology significantly increased the specificity (up to 90%).Routine cytology is a simple, non-invasive and cost-effective method for routine control and screening of dysplastic oral/oropharyngo-/laryngeal lesions. In doubtful cases, the addition of CK-8-immunocytology is very helpful for the distinction of reactive from neoplastic cases.
We review the current knowledge on alterations of the major basement membrane (BM) components and their cellular integrin receptors in benign and malignant tumors of epithelial and mesenchymal origin. While benign tumors usually exhibit a continous BM, recent analyses provide evidence that invasive growth of carcinomas coincides with (a) a loss in a proper BM, (b) changes in the type of integrin receptor expression and (c) the retained ability of certain tumor cells to synthesize matrix components. This latter aspect has been regarded as a potentially beneficial 'host' mechanism against invasive growth. This assumption is strongly supported by the finding of a positive correlation between the extent of BM loss and both a lesser degree of tumor differentiation and a worse prognosis of tumor growth. The resulting concept indicates that in carcinomas an imbalance in the cell-matrix interaction is the leading element in invasive growth. In mesenchymal tumors a somewhat different role of the BM can be observed. Thus, the qualitative and quantitative expression of major BM components in benign mesenchymal tumors closely relates to the BM pattern of normal tissues providing a histogenetically oriented classification of benign mesenchymal tumors. Most well-differentiated sarcomas retain a BM pattern close to that of the histogenetically related tissue, although in poorly differentiated sarcomas no such attribution to a histogenetic orientation of the tumor cells can be found.
