Jürgen Bier

Evaluation of Metastases and Reactive Lymph Nodes in Doppler Sonography Using an Ultrasound Contrast Enhancer

RATIONALE AND OBJECTIVES The authors conducted a prospective study in D-galactose signal-enhanced Doppler sonography of lymph nodes to investigate new aspects in differentiating malignant from reactive lymph nodes of patients with suspected malignancy of the neck. METHODS Twenty-one patients with suspected squamous epithelial cell carcinoma metastases of the neck were examined by Doppler sonography before and after administration of an ultrasound signal-enhancing agent, consisting of D-galactose microbubbles. Qualitative sonomorphology, peak flow rates, and pulsatility and resistive indices were assessed. RESULTS Compared with conventional Doppler, enhanced Doppler sonography gave detailed additional information about vascularization of metastases or reactive lymph nodes. Signal-enhanced Doppler of metastases showed a relatively characteristic pattern of vascularity, therefore facilitating differential diagnoses and allowing better discrimination from surrounding tissue, demonstrated by the infiltration of neighboring vessels in the neck. Concerning reactive lymph nodes, vascularization could be stated and measured in many cases only after signal enhancement. Evaluating peak velocities and pulsatility and resistive indices could not differentiate significantly malignant from reactive lymph nodes. CONCLUSIONS Administration of a D-galactose-based signal-enhancer helps to differentiate malignant from reactive lymph nodes of the neck. It is superior to conventional Doppler by improving evaluation of the vascularity and could be of use for staging procedures.

Role of high-resolution magnetic resonance imaging for differentiating melanin-containing skin tumors.

RATIONALE AND OBJECTIVES.The aim of the study was to evaluate the use of high resolution magnetic resonance imaging (MRI) for differentiation of melanin-containing skin tumors. METHODS.Twenty-seven melanocytic nevi and 18 malignant melanomas were examined by high resolution MRI. Signal intensities and signal-to-noise (SNR) and contrast-to-noise ratios (CNR) of the tumors were determined in unenhanced (T1, T2, water-suppression, and fat-suppression sequences) and contrast-enhanced images (T1 and fat-suppression sequences). The differences were tested for significance by a Wilcoxon test. RESULTS.Malignant melanomas differed from melanocytic nevi in that they displayed a higher SNR in T2-weighted and unenhanced and contrast-enhanced fat-suppression scans. Malignant melanomas exhibited a higher CNR than did benign lesions in unenhanced and contrast-enhanced fat-suppression sequences with dermis as reference tissue (P < 0.05) and in enhanced fat-suppression sequences with subcutis as reference tissue (p < 0.05). CONCLUSIONS.The usefulness of SNR and CNR analysis on MRI for the differentiation of malignant skin tumors from benign skin tumors of the melanin-containing system is limited. Clinical and histologic examinations are, further, the important step in evaluation of melanin-containing skin tumors.

Regeneration of intraoral defects after tumor resection with a bioengineered human dermal replacement (Dermagraft).

&NA; The experiences of seven patients with squamous cell carcinomas of the oral cavity who underwent reconstruction with a bioengineered human dermal replacement (Dermagraft) are examined. The human dermal replacement consists of fibroblasts seeded onto a three‐dimensional polymer scaffold to create a living dermal structure. In this setting, the fibroblasts secrete a mixture of growth factors and matrix proteins in physiological concentration that is essential for wound healing and epithelization. The fibroblast tissue remains metabolically active after cryopreservation and can be used as an off‐the‐shelf tissue to cover medium‐sized defects and avoid donor‐site morbidity. In the first series of patients treated with this tissue, defect closure was achieved without functional problems, allowing optimal postoperative monitoring for tumor recurrence. (Plast. Reconstr. Surg. 109: 889, 2002.)

Docetaxel (Taxotere) in recurrent high grade mucoepidermoid carcinoma of the major salivary glands

Abstract Malignant tumours of the salivary gland are rare entities and are treated primarily surgical. Recurrent salivary gland malignancies present difficult therapeutic decisions and in many instances poor prognosis. Four pre-treated patients with relapse of high grade mucoepidermoid carcinoma originating in the major salivary glands presented in our clinic with extended tumours. Chemotherapy was initiated with docetaxel (Taxotere) 100 mg/m2. After six cycles two complete remissions and two partial remissions were achieved. Al patients remained stable for at least 18 months. Docetaxel in the context of recurrent salivary gland cancer is a viable option.

Immunohistochemical assessment of the tumour-associated epitopes CD44v6 and E48 in tumour-free lymph nodes from patients with squamous cell carcinoma in the head-neck region

We examined immunohistochemically 370 tumour‐free lymph nodes from 41 patients with a head and neck squamous cell carcinoma (HNSCC) to clarify whether the tumour‐associated epitopes CD44v6 and E48 are suitable for adjuvant postoperative immunotherapy. All the positively immunostained cells found were single cells. CD44v6+ cells were found in 55% of the lymph nodes, with their numbers increasing in pN>0‐patients (62%). Only pN>0‐patients had abundant to massive CD44v6+ cells. A comparison with mononuclear cells in lymphatic tissue from control patients suggested a similarity with activated T‐cells. In the 41 cancer patients there were significantly fewer lymph nodes with E48+ cells (11%), but the number of E48+ cells increased in pN>1‐patients (29%) with predominantly abundant E48+ cells. We conclude from the comparison with the epithelial marker EMA that the E48+ single cells are epithelial in origin. Only a specific E48 peptide sequence appears suitable for adjuvant immunotherapy in patients with head‐neck tumours.

Benign symmetric lipomatosis (Madelung’s disease) complicated by involvement of the facial nerve

Benign symmetrical lipomatosis (Madelung’s disease) is a rare disease of unknown etiology which is characterized by the diffuse growth of non-encapsulated lipomas, usually on the neck and upper trunk. Given the benign nature of the lesion, surgical debulking is the treatment of choice, with liposuction reserved for smaller lesions. A 60-year-old man presented in our clinic with progressive tumor growth especially in the cheek. Intraoperatively all branches of the facial nerve were found to be covered by the lipoma. Although Madelung’s disease is a benign lesion, the location of lipoma with possible involvement of vital structures may influence the choice of treatment.

Doppelseitige Rehabilitation mit einer implantatfixierten Orbitaepithese

Ein Patient kann nach Verlust seines Auges in der Regel durch Eingliederung einer Augenprothese aus Glas ästhetisch vollständig rehabilitiert werden. Bei starker Alteration der filigranen Strukturen der Lider oder des Augenprothesenlagers wird die Versorgung schwieriger, so daß manchmal kein kosmetisch befriedigendes Ergebnis erreichbar ist. Hier bietet sich die Rehabilitation mit einer Orbitaepithese als Alternative an. Ein sicherer Halt erfolgt über kraniofaziale Implantate. Während die einseitige Rehabilitation häufiger durchgeführt wird, ist eine doppelseitige Versorgung eine Rarität. Hier wird von einem solchen Fall nach doppelseitiger Augenentfernung und epithetischer Rehabilitation aufgrund von beidseitig aufgetretenen Retinoblastomen berichtet. From the aesthetic point of view, a patient can be completely rehabilitated after the loss of an eye with the insertion of an artificial eye made of glass. If the delicate structures of the eyelids have been severely damaged, however, or if the eye socket does not provide adequate retention for an eye prosthesis, rehabilitation becomes more difficult, and sometimes cannot be achieved with a cosmetically satisfactory result. In such cases, a facial prosthesis offers an alternative solution. Stable retention can be ensured with craniofacial implants. Single-sided rehabilitation by this method is quite common, but bilateral treatment is a rarity. We report on the prosthetic rehabilitation of a patient after exenteration on both sides due to retinoblastomas.

Application of different visualization concepts in the navigated image viewer

In this paper we describe a new system for the navigated viewing of medical image data and the different visualization concepts being realized within the system and discuss the usefulness of the different visualization modes. The system comprises a compact and mobile viewing device that can be tracked by an optical position sensor. It is capable of displaying reasonable parts of a medical image data set (i.e. CT) on its screen in relation to the spatial position regarding a patient. Requirements of simple integration in a clinical environment and various visualization modes, to be applied in maxillofacial surgery are described.