Rhabdomyosarcoma in the area of the head-neck. A synopsis of some cases, therapeutic possibilities and prognoses

BACKGROUND: Soft tissue sarcoma represent approximately 7% of all neoplasms in children up to 14 years. The most common type (approx. 50%) among them is the rhabdomyosarcoma (RMS). Within the head and neck, which accounts for approx. 35% of all RMS, the tumor can be found ubiquitiously. Preferred localizations are the orbita, the paranasal sinuses, and the soft tissue of cheek and neck. The prognosis of RMS was formerly poor but has markedly improved since defined multimodal therapy was established in the Seventies (for example the Intergroup Rhabdomyosarcoma Study, IRS, in 1972; the International Society of Paediatric Oncology, SIOP, in 1975, or the German "Cooperative Weichteil-Sarkom-Studien", CWS, in 1981). The therapy of choice for RMS, according to the CWS, is chemotherapy because very often a good remission of the tumor is achieved. The main role of surgery is first to obtain biopsy specimens for histological diagnosis, and second aim is the complete resection of the primary and resectable metastases, for example by a neck dissection. Severe mutilation by radical surgery, especially in childhood, should be avoided in favor of multidrug chemotherapy and radiation in the interest of patient well-being. PATIENTS: Our retrospective study shows the treatment and results of 11 patients with a rhabdomyosarcoma of the head and neck within 25 years (1972-1997). RESULTS: Five of the 11 patients, who were treated in the years 1972-77, died (average 13 months, range 3-72 months). Five of the six patients, who were treated since 1991, have survived to date, one had a relapse of the tumor. Four special cases of patients are discussed in greater detail. CONCLUSION: Although the achieved mean survival time is encouraging nowadays (a 5-year survival rate of approx. 70% for all RMS is described) fatal cases are typical for this malignancy. Early diagnosis, localization, histological subtype, and prompt initiation of adequate treatment is decisive for a successful outcome.     

Pedicled and microvascular reanastomosed transplants for reconstruction in the head-neck area

In seizures starting gradually, careful examination of the background is required to determine the time and region of onset. We propose a method for displaying EEG variables which characterize seizure onset: changes in amplitude and in average frequency compared to background. These variables are displayed topographically for each EEG channel so that 1 or 2 min of EEG may be viewed on a standard screen, thus representing pre-ictal and ictal periods. We evaluated the ability of this display to indicate seizure onset, by comparing the times and regions of seizure onset indicated by traditional EEG and by the display. The comparison was performed on 30 seizures from scalp recordings and 49 seizures from depth recordings. Seizures were selected for having a gradual onset with no or minimal artefact. Onset times from traditional EEG and the computer method, examined independently, coincided (within 3 sec) in 77% of scalp seizures and 63% of depth seizures. In 14% of seizures the computer display indicated an onset more than 3 sec earlier than visual examination; upon reexamination, however, this onset was thought to be possibly correct. This quantitative display, which in practice should be used with traditional EEG, may thus be useful for computer-assisted seizure interpretation and for a condensed representation of seizures.     

Somatic gene therapy in squamous epithelial carcinomas of the head-neck area

Gene therapy is an important new approach to the treatment and prevention of human diseases. Somatic gene therapy involves the introduction of novel genetic material into somatic cells to express therapeutic gene products. Two main strategies in somatic gene therapy of cancer are applied: the genetic correction of the defect, or the elimination of cancer cells by cytotoxic drugs or the immuno system. Gene transfer can be accomplished by physical and chemical methods or nonreplicating viruses. The different transfer systems vary strongly in their efficiency of transfection, plasmid maintenance, and protein expression. The clinical application could be performed in two ways: Firstly, by in vivo application of genome modifying substances injected directly into the tumour; secondly, by ex vivo application of genetically modified tumour cells as a tumour vaccine. The following review will discuss some of the gene therapy strategies that could be effective in managing head and neck cancer.     

Current status and future possibilities of transjugular intrahepatic portosystemic shunts in the management of portal hypertension

Transjugular intrahepatic portosystemic shunt (TIPS) is an exciting new method for treating complications of cirrhosis. Technical advances have allowed TIPS to be widely applied in the treatment of variceal bleeding. This article presents and discusses the results of recent experiences in TIPS placement. TIPS can be successfully placed in almost all patients. The complication rate of the procedure is low. TIPS is an effective means of controlling variceal bleeding and is especially useful for controlling bleeding in patients awaiting liver transplantation. It may also have a role in the treatment of ascites and other conditions related to portal hypertension. The most important issue facing TIPS is the long-term patency of the shunt. Potential solutions to the problem of long-term shunt patency are discussed.     

Current status of cataract surgery. Modern methods--internal medicine risk factors and contraindications

Modern cataract surgery is characterized by minimal invasive techniques that have been introduced during the past decade. These include phacoemulsification, capsulorhexis, foldable intraocular lenses and small tunnel incisions. High success rates coupled with low complication rates have resulted in a change in indications--cataract surgery is no longer performed merely to prevent blindness, but also to improve vision in patients whose professional or private visual demands are compromised by the onset of lens opacification. To ensure that their cooperation with the ophthalmic surgeon results in optimal benefit to the patient, it is important for general practitioners and internists to be conversant with the risk factors and contraindications for cataract surgery.     

Diagnosis and therapy of vascular malformations in the head-neck area and their differentiation form hemangiomas]

The classification of vascular anomalies is controversial since the same terms are applied for different lesions. The biological classification according to Mulliken and Glowacki is based on the correlation of cellular features of vascular lesions during infancy and childhood with the physical examination and natural history. On this basis, two main categories of vascular anomalies can be distinguished: 1. Hemangiomas with endothelial proliferation and clinical course of rapid postnatal growth followed by slow involution. 2. Vascular malformations as developmental anomalies with normal endothelial cell cycles. These are subdivided according to the part of the vascular system involved.     

Imaging of the knee. Current status

This article reviews the variety of imaging modalities that are currently being used to evaluate the knee. Nuclear scintigraphy is discussed with emphasis on prosthesis abnormalities. Sonography is discussed with regard to the evaluation of popliteal masses. The uses of computed tomography, especially in the evaluation of the tibial plateau fracture, are discussed, and the role of fluoroscopy, computed tomography, and sonography in image-guided needle procedures are reviewed. Emphasis is placed on the role of MR imaging in knee imaging, with attention to internal derangements, bursal and capsular pathology, and other assorted intra- and extra-articular disorders. The focus of this article is to review the wealth of information that may be obtained by using these imaging modalities.     

Cholera in Mexico. Current epidemiologic status

Several over-produced esterases confer resistance to organophosphorus insecticides in the Culex pipiens complex. We describe their distribution in islands and countries of the Caribbean region based on new collections and previous studies, and discuss the need to: 1) undertake DNA studies to correctly identify the esterase B alleles that are amplified in different regions, and 2) investigate the variability among gene copies within each amplification system in order to fully understand their origin and their evolution through time.     

Current status of biofeedback in clinical practice.

Discusses the advancements, limitations, and professional issues involved in the development of biofeedback in clinical practice. Biofeedback is defined, and current instrumentation and applications are described in the context of the history, physiology, procedures, and major clinical uses. Precautions and contraindications are listed. It is noted that the therapist needs to remain informed concerning issues such as practice standards and ethics, insurance, and recent advances. National and state societies have been established, training programs and certification examinations have been implemented, and state and federal legislation have implications for the future of biofeedback. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)