Traumatic brain injury (TBI) is a leading cause of death and disability for which there is currently no effective drug therapy available. Because drugs targeting a single TBI pathological pathway have failed to show clinical efficacy to date, pleiotropic agents with effects on multiple mechanisms of secondary brain damage could represent an effective option to improve brain recovery and clinical outcome in TBI patients. In this multicenter retrospective study, we investigated severity-related efficacy and safety of the add-on therapy with two concentrations (20 ml/day or 30 ml/day) of Cerebrolysin (EVER Neuro Pharma, Austria) in TBI patients. Adjunctive treatment with Cerrebrolysin started within 48 hours after TBI and clinical outcomes were ranked according to the Glasgow Outcome Scale and the Modified Rankin Disability Score at 10 and 30 days post-TBI. Analyses of efficacy were performed separately for subgroups of patients with mild, moderate or severe TBI according to Glasgow Coma Scale scores at admission. Compared to standard medical care alone (control group), both doses of Cerebrolysin were associated with improved clinical outcome scores at 10 days post-TBI in mild patients and at 10 and 30 days in moderate and severe cases. A dose-dependent effect of Cerebrolysin on TBI recovery was supported by the dose-related differences and the significant correlations with treatment duration observed for outcome measures. The safety and tolerability of Cerebrolysin in TBI patients was very good. In conclusion, the results of this large retrospective study revealed that early Cerebrolysin treatment is safe and is associated to improved TBI outcome.

BACKGROUND Patients with an history of carcinoma of the upper aerodigestive tract are at high risk for recurrence or the development of new tumors in this region. In the majority of follow‐up protocols, these patients undergo radiologic and endoscopic evaluation as a means of surveillance for the early detection of recurrence. The brush biopsy‐capsule technique represents a noninvasive and inexpensive screening device for this patient population. In the current study, the authors retrospectively assessed the sensitivity, specificity, and predictive value of esophageal brush‐capsule cytology for the detection of malignant lesions of the upper aerodigestive tract in this high risk patient population. METHODS Cytologic specimens from 334 patients with previously treated upper aerodigestive malignancies were available for review. The cytologic, endoscopic, and clinical follow‐up of each case were studied over a follow‐up period of 3 years. Gold standard was the clinical follow‐up for the negative cases (who were not submitted to biopsy) and biopsy for the positive cases. Sensitivity, specificity, and predictive value were calculated. RESULTS Using cytology 33 malignancies were detected in 25 patients during a 3‐year follow‐up period. The test was found to have a sensitivity of 88.7% and a specificity of 90.7%. In 66% of cases the malignancies were located in the oropharynx; the others were located in the esophagus. In 70% of cases the malignancies were detected at an early stage. CONCLUSIONS Esophageal brush‐capsule cytology is a simple noninvasive technique that has been proven to be useful in the early detection of metachronous and recurrent neoplasms in the follow‐up of patients with previously treated carcinomas of the ear, nose, and throat. Cancer (Cancer Cytopathol) 2000;90:10–6. © 2000 American Cancer Society.

Colposcopic evaluation after a repeated Pap smear with ASCUS is an appropriate cost-effective management. Finding 30% of LSIL or HSIL justifies this additional investigation.

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For patients with head and neck cancer, abrasive sponge cytology is useful for detecting esophageal cancer at an early stage. In addition, it may reveal unsuspected second primaries or recurrences in the head and neck region.