V Hofmann

Efficacy and toxicity of docetaxel combination chemotherapy for advanced squamous cell cancer of the head and neck

The aim of the present study was to evaluate the clinical effectiveness and toxicity of docetaxel with 5-fluorouracil and cisplatin as combination treatment in patients with curable or metastatic/recurrent head and neck cancer by a retrospective cohort study of patients treated at a single institution between 2007 and 2012. Patients with locally advanced, metastatic and/or recurrent squamous cell carcinoma of the head and neck (SCCHN), who were treated with a combination therapy including docetaxel, were considered as eligible. Survival data, clinical side effects, quality of life (QoL) and toxicity profile were retrieved from patient charts, analyzed and scored according to the National Cancer Institute Common Toxicity Criteria, version 4, and the Response Evaluation Criteria In Solid Tumors, version 1.1. An overall response rate of 86% and a 3-year survival of 65.1% were observed. The median progression-free survival was 32 months. The cumulative incidence after 3 years was 16.9% for local recurrence and 10.4% for distant metastasis. Leukopenia (58%) and anemia (51%) were the most common hematological toxicities, followed by hepatotoxicity (53%) and nausea (27%). A total of 31% of the patients experienced a compromise in their QoL following therapy completion. In conclusion, docetaxel in combination with cisplatin and 5-fluorouracil was found to effectively prolong survival in patients with locally advanced and/or recurrent metastatic SCCHN. The overall survival, progression-free survival and response rates were in accordance with those reported by previous clinical trials. Therefore, this therapy protocol is recommended for patients with SCCHN in the curative as well as the palliative settings.

Prevalence and associated survival of high-risk HPV-related adenoid cystic carcinoma of the salivary glands

Adenoid cystic carcinoma (SACC) is a rare malignancy, but a frequent subtype in minor and major salivary glands. The molecular alterations or biomarkers that underlie its development and progression as well as therapy outcomes are poorly characterized. The main study goal was to investigate reliable biomarkers and patient-related factors that may have impact on recurrence and long-term survival of SACC. The prevalence of human papilloma virus (HPV) in SACC was determined by HPV-DNA genotyping and p16 immunostaining. Epithelial growth factor receptor (EGFR), p53 and Ki-67 expression were also evaluated. Twenty-eight (42%) of 67 patients were HPV-DNA positive. Kaplan-Meier analysis indicated that SACC patients with metastases (P=0.03) had a poor overall survival (OS) and a shorter recurrence-free survival (P<0.001). Positive resection margins significantly predicted shorter recurrence-free survival (P=0.01). In the multivariate analysis, non-metastatic disease (P=0.033) and p16 positivity (P=0.005) have shown their prediction value for OS while non-metastatic disease (P=0.002), HPV positivity (P=0.041) and negative resection margin predicted a better recurrence-free survival. The present study documents for the first time the positivity for HPV infection and overexpression of certain markers (p16, Ki-67, EGFR and p53) used in diagnostics in SACC as well as characterizes clinical entities. These factors might be exploited in the future as biomarkers for its prognostic value. Using the clinical and pathological basis for predicting different outcomes could significantly facilitate SACC stratification and potentially directing treatment.

[Tonsillectomy in adults: Length of hospital stay has no influence on the frequency of postoperative hemorrhage].

BACKGROUND Tonsillectomies (TE) in Germany are traditionally performed during inpatient hospital stays. Socioeconomic changes in the healthcare system have resulted in shorter hospital stays. OBJECTIVES The aim of the study was to investigate whether a shorter hospital stay of 2 days leads to increased postoperative bleeding after TE. Factors affecting the duration of hospitalization were also studied. MATERIALS AND METHODS The relevant data of all patients (≥ 14 years) undergoing TE in the ENT Clinic of the Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, between 2011 and 2013 were recorded anonymously. Risk factors for bleeding after TE were analyzed. Additionally, patients who had a hospital stay of 2 days (since 2013) were compared with patients hospitalized for ≥ 3 days, and the influence of various risk factors on the length of hospital stay was analyzed. RESULTS During the study period 2011-2013, 376 procedures were performed and data from 213 patients was collected for analysis. Median patient age was 26 years (range 14-73 years). The rate of primary hemorrhage (up to 24 hours after TE) was 2% and the rate of secondary bleeding (later than 24 hours) was 24%. In 7% of patients with postoperative haemorrhage (primary and secondary) surgical hemostasis was performed. Male gender was associated with a significantly higher haemorrhage rate. Shortening postdischarge surveillance to only 2 days did not affect the postoperative bleeding rate. CONCLUSION The duration of stationary monitoring following TE should not only be based on the rate of secondary bleeding, but also on patient comfort and safety. A shortening of postoperative monitoring to only 2 days had no effect on the haemorrhage frequency after TE and can therefore, be considered for adults who do not live alone and are within a reasonable distance to a hospital.

Meta-analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation: Cochlear Implantation and Complaints of Vertigo

Postoperative vertigo is a common complaint after cochlear implantation, but published incidence rates differ vastly. The aim of the present study was to investigate both subjective complaints of vertigo before and after cochlear implantation and related vestibular diagnostic tests on cochlear implant candidates.

Massive Blutung bei einer Parazentese: Übersicht anhand eines Fallberichts

Report of a rare case of severe bleeding from the middle ear cavity after myringotomy. On the basis of the case report, the procedure for such bleeding is discussed in the context of the literature. A 6-year-old boy received a revision myringotomy in an ambulant setting. During the procedure a severe bleeding occurred. The external auditory canal was adequately packed. The patient was extubated and transferred to the clinic as an emergency. Computer tomography of the temporal bone showed the anatomical variant of a dehiscent high jugular bulb, which had been injured. Because no rebleeding occurred, the packing of the ear canal was removed and an explorative tympanoscopy was performed on the third postoperative day. When the tympanomeatal flap was lifted, the defect in the jugular bulb was found. The lesion was covered with Tutopatch® pads and fibrin glue and the auditory canal was packed again. After removal of the packing three weeks postoperatively a properly healed situs was found. No further measures were taken. The injury of a dehiscent jugular bulb in the course of ear surgeries leads to a massive hemorrhage. The case describes the diagnostic and therapeutic procedure for this relatively rare but severe complication.

Tonsillektomie bei Erwachsenen@@@Tonsillectomy in adults: Kein Einfluss der stationären Aufenthaltsdauer auf die Nachblutungshäufigkeit@@@Length of hospital stay has no influence on the frequency of postoperative hemorrhage

BACKGROUND Tonsillectomies (TE) in Germany are traditionally performed during inpatient hospital stays. Socioeconomic changes in the healthcare system have resulted in shorter hospital stays. OBJECTIVES The aim of the study was to investigate whether a shorter hospital stay of 2 days leads to increased postoperative bleeding after TE. Factors affecting the duration of hospitalization were also studied. MATERIALS AND METHODS The relevant data of all patients (≥ 14 years) undergoing TE in the ENT Clinic of the Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, between 2011 and 2013 were recorded anonymously. Risk factors for bleeding after TE were analyzed. Additionally, patients who had a hospital stay of 2 days (since 2013) were compared with patients hospitalized for ≥ 3 days, and the influence of various risk factors on the length of hospital stay was analyzed. RESULTS During the study period 2011-2013, 376 procedures were performed and data from 213 patients was collected for analysis. Median patient age was 26 years (range 14-73 years). The rate of primary hemorrhage (up to 24 hours after TE) was 2% and the rate of secondary bleeding (later than 24 hours) was 24%. In 7% of patients with postoperative haemorrhage (primary and secondary) surgical hemostasis was performed. Male gender was associated with a significantly higher haemorrhage rate. Shortening postdischarge surveillance to only 2 days did not affect the postoperative bleeding rate. CONCLUSION The duration of stationary monitoring following TE should not only be based on the rate of secondary bleeding, but also on patient comfort and safety. A shortening of postoperative monitoring to only 2 days had no effect on the haemorrhage frequency after TE and can therefore, be considered for adults who do not live alone and are within a reasonable distance to a hospital.

Tonsillektomie bei Erwachsenen

BACKGROUND Tonsillectomies (TE) in Germany are traditionally performed during inpatient hospital stays. Socioeconomic changes in the healthcare system have resulted in shorter hospital stays. OBJECTIVES The aim of the study was to investigate whether a shorter hospital stay of 2 days leads to increased postoperative bleeding after TE. Factors affecting the duration of hospitalization were also studied. MATERIALS AND METHODS The relevant data of all patients (≥ 14 years) undergoing TE in the ENT Clinic of the Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, between 2011 and 2013 were recorded anonymously. Risk factors for bleeding after TE were analyzed. Additionally, patients who had a hospital stay of 2 days (since 2013) were compared with patients hospitalized for ≥ 3 days, and the influence of various risk factors on the length of hospital stay was analyzed. RESULTS During the study period 2011-2013, 376 procedures were performed and data from 213 patients was collected for analysis. Median patient age was 26 years (range 14-73 years). The rate of primary hemorrhage (up to 24 hours after TE) was 2% and the rate of secondary bleeding (later than 24 hours) was 24%. In 7% of patients with postoperative haemorrhage (primary and secondary) surgical hemostasis was performed. Male gender was associated with a significantly higher haemorrhage rate. Shortening postdischarge surveillance to only 2 days did not affect the postoperative bleeding rate. CONCLUSION The duration of stationary monitoring following TE should not only be based on the rate of secondary bleeding, but also on patient comfort and safety. A shortening of postoperative monitoring to only 2 days had no effect on the haemorrhage frequency after TE and can therefore, be considered for adults who do not live alone and are within a reasonable distance to a hospital.