J. Piffko

Gains and losses of adhesion molecules (CD44, E‐cadherin, and β‐catenin) during oral carcinogenesis and tumour progression

The aim of this study was to define whether or not the impaired expression of CD44, E‐cadherin (E‐cad), and β‐catenin (β‐cat) correlates with the clinical evolution and prognosis of oral cancer. Ninety‐three primary oral squamous cell carcinomas (OSCCs) with tumour‐adjacent normal and/or dysplastic mucosa, 30 associated metastases, and 12 recurrences were immunostained for CD44s, ‐v3, ‐v4, ‐v5, ‐v6, ‐v7, ‐v9, E‐cad, and β‐cat. In non‐neoplastic epithelium, all molecules investigated were constitutively expressed in the basal layers. In the majority of dysplasias, immunoreactivity for all adhesion molecules was increased, but there was restricted loss for CD44s, E‐cad, and β‐cat in a few cases. In carcinomas, a striking accumulation of CD44s, v3, v4, v9 and a loss of E‐cad/β‐cat were observed at the invasive tumour front. In metastases and recurrences, besides a loss of CD44s, v4, v7, and E‐cad, a significant increase of v9 was recorded, whereas CD44v5 and v6 remained unchanged. Clinically, reduced expression of CD44v3, E‐cad, and changes of CD44v9 phenotype within the primary tumours correlated significantly with poor prognosis; decreased β‐cat expression was a predictive marker for nodal metastases. These findings indicate that there is some perturbed expression of adhesion molecules during the stepwise course of oral carcinogenesis and tumour progression. Distinct phenotypic alterations project poor prognosis, while others predict metastasis. Some of these restricted molecular changes may serve as potential targets for future antibody‐based tumour therapy. Copyright

Molecular assessment of p53 abnormalities at the invasive front of oral squamous cell carcinomas

The prognostic significance of the invasive tumor front in squamous cell carcinomas has recently been recognized. The aim of the present study was to investigate possible molecular mechanisms underlying the significance of this area in oral squamous cell carcinomas.

In situ assessment of cell proliferation at the invasive front of oral squamous cell carcinomas

In oral squamous cell carcinoma (OSCC) the histopathological malignancy grading of the invasive front has been found to offer the most reliable prognostic parameter. In the present study we compared such tumour front grading of 100 OSCCs with the in situ growth fraction demonstrated by MIB1 immunostaining following wet autoclave antigen retrieval. MIB1 labelling indices (LIs) were estimated both at the invasive front and in the central parts of OSCCs using two different evaluation methods (overall and random counting) to investigate whether MIB1 LIs represent a possible biological background for the tumour front grading. Statistically highly significantly increased MIB1 LIs were found at the invasive tumour fronts with both counting methods compared with the centres of the same tumours. For LI estimation the classic overall counting procedure proved to be superior. However, in contrast to tumour front grading, MIB1 LIs revealed no correlation with the clinical outcome of the patients concerned. Our results demonstrate that the invasive tumour front of an OSCC is composed of (a) tumour subpopulation(s) with higher proliferative activity. However, determination of the proliferative activity by MIB1 of this tumour area offers no prognostic information.

3D evaluation of postoperative swelling using two different cooling methods following orthognathic surgery: a randomised observer blind prospective pilot study

Orthognathic surgery is associated with side effects including severe postoperative swelling, pain, neurological dysfunction and trismus. The beneficial effects of localised cold treatment on postoperative swelling have been described. Topographical considerations make it difficult to quantify facial swelling. A new and promising method to measure facial swelling seems to be optical face scanning. This study aimed to evaluate the 3D optical scanner to measure soft tissue swelling following orthognathic surgery. Postoperative swelling was treated either with conventional cooling by cold packs or with the water-circulating cooling device Hilotherm Clinic. Secondary endpoints in each group included postoperative pain, neurological complaints, duration of hospital stay, trismus and patient satisfaction. The use of the cooling device by Hilotherm significantly reduced postoperative swelling, pain and hospital duration compared with conventional cooling. Postoperative trismus and satisfaction with the cooling method was significantly higher in the Hilotherm group compared with conventional cooling. No differences were observed concerning neurological score and outcome. In conclusion, 3D optical scanning is a simple and precise method of quantifying face swelling after orthognathic surgery. Hilotherm significantly reduces swelling and duration of hospital stay compared with conventional cooling.

Standardized AgNOR analysis of the invasive tumour front in oral squamous cell carcinomas

In the last decade, silver staining of nucleolar organizer region‐associated proteins (AgNORs) has been widely used in tumour pathology both for diagnostic and for prognostic purposes. However, a reliable and reproducible assessment of these proteins on routinely processed archival tissues has only become possible since the recent introduction of standardized staining method and computer‐aided morphometric analysis. In the present study, the AgNOR content at the invasive front of 80 squamous cell carcinomas of the floor of the mouth/tongue was investigated using this novel approach, with regard to prognosis and a variety of clinico‐pathological parameters. All standardized AgNOR parameters [mean of AgNOR number, mean of AgNOR area, coefficients of variation (CV) of both AgNOR number and area] were statistically significantly associated with the clinical course. The strongest correlation was found for the AgNOR‐area univariate analysis (P=0·006). In multivariate analysis, the mean of AgNOR number could independently predict both overall (P=0·01) and disease‐free survival (P=0·001). It is concluded that standardized staining and computer‐aided analysis of AgNORs are prerequisites for an objective and reproducible AgNOR assessment, which has potential as a supplementary diagnostic and prognostic tool in oral cancer.

Behandlung von frontobasalen Traumen und Polytraumen

Hintergrund: Diese Arbeit beschreibt die historische Entwicklung sowie den aktuellen Stand der Behandlung von Patienten mit Frontobasisverletzungen und polytraumatisierten Patienten aus Sicht der Mund-Kiefer-Gesichts-Chirurgen. Behandlungskonzept: Basierend auf langjähriger Erfahrung wurde ein diagnostisches und therapeutisches Behandlungskonzept entwickelt, welches sich in den vergangenen 5 Jahren an 320 Polytraumapatienten mit ¶90 Frontobasisverletzungen bewährte. Background: This paper describes the historical development as well as current concepts of frontobasal fracture treatment by maxillofacial surgeons. Treatment concept: Based on the experience of many years a diagnostic and therapeutic treatment concept was developed, which proved to be adequate in 320 patients with 90 frontobasal fractures in the last five years.

Feuchtes Autoklavieren Der einfachere Weg zur Antigendemaskierung

ZusammenfassungMit der Technik des feuchten Autoklavierens wird eine einfache, verläßliche und zeitsparende Methode zur Antigen-Demaskierung an Formalin-fixiertem und Paraffin-eingebettetem Gewebe vorgestellt. Anhand einer Reihe von Antikörpern (Östrogen- und Progesteronrezeptoren, Zytoskelettproteine, verschiedene p53-Antikörper, mdm-2, bcl-2, MIB-1 u. a.) verwendeter Antikörper werden die Vorteile dieser Methode beschrieben. Das feuchte Autoklavieren ermöglicht bei einigen sonst nur am Gefrierschnitt einsetzbaren Antikörpern auch deren Anwendung am Paraffinschnitt. Für den Routinepathologen ist die leichte Handhabung sowie die hohe Reproduzierbarkeit von Vorteil.SummaryWet autoclaving is a simple, reliable and time-effective method for antigen retrieval in routinely processed archival material. Both routine diagnostic (e. g., oestrogen and progesterone receptors, cytoskeletal proteins) and research antibodies (e. g. various p53 antibodies, mdm-2, bcl-2, MIB-1) are reported to demonstrate its application. Wet autoclaving may allow successful application of antibodies in paraffin-embedded tissues designed for use on frozen sections. The technique has the poten-tial to reliably handle up to 200 sections at a time, without evidence of any significant damage to the sections or nuclear morphology.

Neue Aspekte in der Versorgung von Unterkieferfrakturen

Hintergrund: Das Ziel von chirurgischen Maßnahmen zur osteosynthetischen Versorgung von Unterkieferfrakturen besteht in der knöchernen Stabilisierung und Ausheilung des Frakturspalts. Es ist dabei anerkannt, dass der Abstand und die Bewegung der knöchernen Fragmente die Frakturheilung entscheidend beeinflussen. Literatur: Die unter dem Begriff Stabilität verstandene Fragmentfixation wird in der Literatur nur ungenau definiert. Genaue biomechanische Daten zum Frakturspaltverhalten unter Belastung sind kaum erhältlich. Daneben sind die Zell- und Gewebeprozesse einer mechanisch modulierten Knochenregeneration nur unzureichend bekannt. Modell: In diesem Artikel wird ein tierexperimentelles Modell zur Evaluierung der Reaktion des knöchernen Regeneratgewebes auf das Vorhandensein von Mikrobewegung beschrieben. In einem In-vitro-Modell wurde zudem die Stabilität von mit verschiedenen Osteosynthesesystemen versorgten Unterkieferfrakturen quantitativ determiniert. Die Implikation dieser Versuche für die osteosynthetische Versorgung von Unterkieferfrakturen wird diskutiert. Background: The aim of osteosynthetic mandibular fracture treatment is a bony bridging of the fracture gap. The gap distance and the fragment movement determine the micromovement in the gap tissue. They are known to be the main factors associated with the clinical outcome of fracture treatment. Literature: The term fracture stability and the underlying mechanically modulated tissue reactions are not well described in the literature. Model: In this article we describe experimental results of strain related bone regenerate reactions in vivo. Additionally, in an in vitro model of osteosynthetic fracture treatment micromovements in the sense of bone strains were determined in the gap area. Implications for the osteosynthetic treatment of mandibular fractures are discussed on the basis of our biological and biomechanical results.

Malignant fibrous histiocytoma of the face: report of a case.

BackgroundSoft tissue sarcomas in the head and neck region are rare and often present a difficult differential diagnosis. The aim of our presentation is to point out the complexity of the diagnosis, treatment and follow up.Case presentationAn eighty-seven year old female patient was referred to our unit with a fast growing brownish lump on the face. Four months beforehand, a benign fibrous histiocytoma (BFH) had been removed from the same location by excision biopsy with wide tumour-free resection margins. Excision biopsy of the recurrent lesion revealed a malignant fibrous histiocytoma (MFH). Radical tumour resection was completed by extended parotidectomy and neck dissection; the skin defect was covered by a regional bi-lobed flap. No adjuvant radio- or chemotherapy was administered. Full functional and cosmetic recovery was achieved; follow-up has been uneventful more than two years postoperatively.DiscussionMalignant transformation of BFH is extremely rare and if so, extended radical surgery may give a fair chance for a favourable outcome even in patients with advanced age.

Significance of wet autoclave pretreatment in immunohistochemistry

Until recently the only way to rescue masked epitopes in routinely processed surgical pathological material was enzymatic digestion. The use of heat for antigen retrieval, first by microwave irradiation, represents an important breakthrough in immunohistochemistry. With the acceptance of microwave oven pretreatment, various modified techniques and alternative heating methods have also been proposed. Wet autoclave pretreatment for tissue proteolysis is a highly reliable alternative to the microwave antigen retrieval technique. It provides uniform heating of the slides, hence an even enhancement of staining intensity in a variety of formalin-sensitive antigens, and it also offers consistent interlaboratory results. The method has been introduced in routine diagnostic immunohistochemistry for the detection of estrogen-and progesterone receptors, L26-, Ki-67- and bcl-2 antigens and variable types of cytokeratins (1/5/10/11, 8, 13, 19). Experimentally, wet autoclaving can be used very successfully for the immunophenotyping of p53 and mdm2 expression, for the detection of adhesion molecules (CD44, integrins) and some anti-inflammatory molecules (annexins), among others. It has produced a substantial improvement in the visualisation of silver-stained nucleolar organizer regionsassociated proteins (AgNORs) in routine paraffin sections and along with modified silver staining and standardized AgNOR parameters assessed by image analysis. Wet autoclaving-based AgNOR staining has been proposed by a European multicentric study group as the standardized method for AgNOR analysis in archival material.