bluuebunny/crossref_metadata_2025 huggingface dataset:
Pilot study of positron emission tomography in patients with advanced head and neck cancer receiving radiotherapy and chemotherapy
Authors: Berlangieri Salvatore U. , Brizel David M. , Scher Richard L. , Schifter Tobias , Hawk Thomas C. , Hamblen Sharon , Coleman R. Edward , Hoffman John M.
Published: February 2007

Background. Positron emission tomography (PET) provides a noninvasive modality for evaluating the biochemical processes of normal and pathologic tissue. Preliminary reports of F‐18 fluorodeoxyglucose (FDG) PET indicate its potential usefulness in evaluating head and neck tumors. The current study was performed to explore the relationship between changes in tumor FDG metabolism and local control in patients receiving hyperfractionated radiotherapy and concurrent chemotherapy.

Methods. The study group consisted of six patients with locally advanced, nonmetastatic squamous cell carcinoma of the head and neck. FDG studies were performed prior to, during, and 24 months post‐therapy. Ratios of tumor to nontumor FDG uptake in regions of interest (ROI) were compared.

Results. All pretherapy studies demonstrated a focal hypermetabolic abnormality corresponding to the known tumor. The pretherapy tumor to nontumor FDG ratios declined significantly during therapy (p < 0.05) with a similar continued trend post‐therapy (p < 0.07).

Conclusion. The treatment‐induced decrease in tumor hypermetabolism as seen on serial FDG PET parallels the clinical response in squamous carcinoma of the head and neck. Two‐year follow‐up scans also suggest that continued low tumor to nontumor ratios reflect eradication of local disease. Because of its high cost, a study of larger numbers of patients is necessary to better define the role of PET in the management of head and neck cancer. © 1994 John Wiley & Sons, Inc.
Intracranial extension of a nasal dermoid sinus cyst in A 56‐year‐old man
Authors: Hacker David C. , Freeman Jeremy L.
Published: February 2007

Background. Nasal dermoid sinus cysts are rare congenital lesions that result from aberrant embryonal development. Cases of nasal dermoids associated with intracranial extension have been reported in the past, but have almost always occurred in children.

Methods. One case of a nasal dermoid cyst with intracranial involvement in a 56‐year‐old man is reported herein.

Results. A 56‐year‐old man presented with a draining sinus in the right medial canthal area and a nasal pit. Imaging studies suggested a nasal dermoid cyst with intracranial extension. He subsequently underwent a craniofacial removal of the lesion with a satisfactory postoperative course.

Conclusion. That nasal dermoid cysts can remain dormant until the age of 56 suggests that the incidence of this lesion with intracranial extension may be higher than previously reported. A one‐stage combined otolaryngologic/ neurosurgical procedure is advocated for those lesions that are extra‐ and intracranial. © 1994 John Wiley & Sons, Inc.
Carcinosarcoma (malignant mixed tumor) of the parotid: Report of a case with a pure rhabdomyosarcoma component
Authors: Gandour‐Edwards Regina F. , Donald Paul J. , Vogt Philip J. , Munn Robert , Min Kyung‐Whan
Published: February 2007

Background. Carcinosarcoma or true malignant mixed tumor of the parotid gland is extremely rare, accounting for <1% of all salivary gland malignancies.

Methods. A 63‐year‐old woman presented with a 5‐cm right parotid mass which was resected with a radical parotidectomy and infratemporal fossa dissection.

Results. The tumor contained two distinctive histologic patterns, that of a poorly differentiated ductal carcinoma and a pleomorphic rhabdomyosarcoma. Additionally, a residual focus of pleomorphic adenoma was present peripherally, Immunohistochemical and electron microscopic studies confirmed the skeletal muscle differentiation.

Conclusions. The pattern of combined rhabdomyosarcoma and ductal carcinoma has not been previously reported and adds further evidence to the myoepithelial derivation of these tumors. © 1994 John Wiley & Sons, Inc.
Medial vs lateral wall pyriform sinus carcinoma: Implications for management of regional lymphatics
Authors: Johnson Jonas T. , Bacon Geoffrey W. , Myers Eugene N. , Wagner Robin L.
Published: February 2007

Background. Our purpose in performing this review is to analyze the relationship between the anatomic site of hypopharyngeal lesions and the pattern of recurrent disease, particularly cervical recurrence. This clinical information can subsequently be used to influence treatment options.

Methods. The records of 169 patients with carcinoma of the hypopharynx treated between 1975 and 1986 were reviewed retrospectively. Patients were classified as having medial wall pyriform sinus disease (MP) lesions, lateral wall pyriform sinus (LP) lesions, posterior wall (PW), or postcricoid (PC) lesions. All patients were followed a minimum of 36 months. Patients with evidence of recurrent carcinoma were characterized according to the site of recurrence.

Results. Recurrent carcinoma in the hypopharynx was noted in seven (4%) of 169 patients. Cervical metastases was the sole site of failure in 27 (16%) of 69 patients, whereas distant metastases developed in 25 (15%) of 169 patients. Failure in the contralateral unoperated neck occurred in 14% (10/71) of patients with MP lesions and, in contrast, 5% (4/76) LP patients. This difference was statistically significant (p = 0.04). Radiotherapy was not effective in preventing cervical recurrence in 20 (74%) of 27 overall neck failures and 11 (79%) of 14 contralateral NO neck failures.

Conclusion. These data suggest that patients with carcinoma involving the MP are at greater risk for contralateral cervical metastases. We recommend bilateral neck dissection be offered to patients with MP lesions. © 1994 John Wiley & Sons, Inc.
Laryngectomy alone for T3 glottic cancer
Authors: Foote Robert L. , Olsen Kerry D. , Buskirk Steven J. , Stanley Robert J. , Suman Vera J.
Published: February 2007

Background.The long‐term survival of 81 patients with T3 squamous cell carcinoma of the glottic larynx treated with laryngectomy alone is presented and pathologic predictors for cancer recurrence above the clavicles and cancer death are identified.

Methods.Clinical records, operative notes, and pathologic slides were reviewed. The major end points were failure above the clavicles, cause‐specific survival, and overall survival. All patients were followed until death or a minimum of 10.8 years.

Results.The main pattern of treatment failure was within an undissected ipsilateral or contralateral neck. Subglottic extension and nodal metastases predicted failure above the clavicles and delayed metastasis within an undissected neck. The 5‐year rate of control of disease above the clavicles, cause‐specific survival, and overall survival were 74.1%, 73.7%, and 54.3%, respectively.

Conclusions.Patients treated with laryngectomy for T3 glottic cancer who have pathologic evidence of subglottic extension or nodal metastasis are at higher risk for recurrence above the clavicles, particularly within an undissected neck. © 1994 John Wiley & Sons, Inc.
Swallowing of bolus types by postsurgical head and neck cancer patients
Authors: Stachler Robert J. , Hamlet Sandra L. , Mathog Robert H. , Jones Lewis , Heilbrun Lance K. , Manov L. Joan , O'Campo Jesus M.
Published: February 2007

Background. Clinically, head and neck cancer patients with anterior resections have better postoperative outcomes than do patients with posterior resections.

Methods. Videofluoroscopy was used to study the swallowing characteristics in postsurgery head and neck cancer patients and normal controls. Most patients received post‐operative radiotherapy and chemotherapy, and no cancer recurrence was noted at the time of study, 4‐8 months post‐treatment. Bolus types included: 3 mL and 10 mL liquid barium, barium paste, and barium‐coated cookie. Temporal measurements and a count of the number of swallows required to ingest each material were made from the video‐taped data. Statistical analysis using an unbalanced univariate repeated measures ANOVA was performed.

Results. The major differences were found between bolus types, with few differences noted between surgical groups (anterior vs posterior resections) and normal controls. Patients took longer to ingest viscous material, accomplishing this by multiple piecemeal and clearing swallows. Coordination of mastication and swallowing of the cookie was different between normal and patient groups.

Conclusions. Patients who are able to swallow reasonably well postoperatively maintain normal coordination and timing of swallowing activity and do not vary these parameters to compensate for structural inadequacy. Instead, repeated swallows are used. © 1994 John Wiley & Sons, Inc.
Nucleolar organizer regions in follicular tumors of the thyroid
Authors: Shem‐Tov Yosef , Straus Michael , Talmi Yoav P. , Rath‐Wolfsom Lea , Zohar Yuval , Gal Rivka
Published: February 2007

Background. Nucleolar organizer regions (NORs) are loops of ribosomal DNA that occur in nucleoli and that transcribe to ribosomal RNA. NORs have been identified by means of the Ag‐NOR technique in routinely processed tissues, and were found to be of discriminative value between some types of benign and malignant lesions.

Methods. Follicular lesions of the thyroid (17 adenomas and 25 carcinomas) were examined. Ten normal thyroids served as the control group. All slides were stained by the Ag‐NOR technique and the number of Ag‐NOR dots were counted in 50 randomly selected cells. The mean number of Ag‐NORs was calculated for each case. Data were statistically analyzed by the Student's unpaired t test.

Results. The mean Ag‐NOR counts were statistically higher in follicular carcinomas as compared to either follicular adenomas or the normal thyroid. Higher Ag‐NOR counts were found in the more aggressively behaving tumors.

Conclusions. It is suggested that the Ag‐NOR technique could be of use as an adjunct to diagnostic histopathology and as an indicator of biologic behavior in follicular tumors of the thyroid. © 1994 John Wiley & Sons, Inc.
Malignant clear cell hidradenoma of the upper lip
Authors: Orlandi Richard R. , Sercarz Joel A. , Doberneck Susan A. , Calcaterra Thomas C.
Published: February 2007

Malignant clear cell hidradenoma is an uncommon tumor of eccrine sweat gland origin that has a predilection for the head and neck. It is characterized by an indolent growth pattern yet frequently recurs following surgical excision and has a high incidence of regional and distant metastases. A case of recurrent malignant clear cell hidradenoma of the upper lip is presented. The lesion was treated with surgical excision followed by radiotherapy. The literature on this rare lesion is reviewed and treatment strategies discussed.
Adenocarcinoma with simultaneous squamous carcinomas of the larynx
Authors: Obermyer Neal E. , Ramadan Hassan H.
Published: February 2007

Background. Primary adenocarcinoma of the larynx is a rare neoplasm. The incidence is reported as less than 1% of all laryngeal neoplasms in multiple series. Simultaneous primary adenocarcinoma and a solitary squamous cell carcinoma of the larynx is even rarer and only one case has been found on review of the literature.

Methods. A case report of a 74‐year‐old man with a history of right‐sided throat pain, odynophagia, and progressive hoarseness is presented with a review of the literature pertaining to this unusual case.

Results. The patient was found to have three distinctly separate laryngeal lesions on direct laryngoscopy. Histopathologic diagnosis of adenocarcinoma was made on one of the three biopsied sites with the other sites being squamous cell carcinoma. Following Combined radiotherapy and surgical treatment, the patient has remained free of disease.

Conclusions. Adenocarcinoma of the larynx is an infrequent and lethal disease. This case report and a review of the literature demonstrate that aggressive surgical management is indicated, although still may not result in improved survival. © 1994 John Wiley & Sons, Inc.
Functional status and coping in patients with oral and pharyngeal cancer before and after surgery
Authors: Langius Ann , Björvell Hjördis , Lind Magnus G.
Published: February 2007

Background. Few studies, prospective or retrospective, exist that describe the quality of life of patients with oral or pharyngeal cancer. This study describes functional status, measured by the sickness impact profile (SIP), and coping, measured by the sense of coherence (SOC) scale, in a group of patients treated by surgery for oral or pharyngeal cancer.

Methods. Forty‐two patients, divided into two groups, participated in the study. Twenty‐seven patients completed SIP and SOC scale 12 months after treatment (the 12‐month follow‐up group), and 15 patients completed SIP and SOC scale before surgery and SIP 2‐4 months and 12 months after treatment (the prospective group). The patients were also classified according to the extensiveness of their surgery: minor, moderate, or major.

Results. The psychosocial and physical functioning as well as the functions of recreation/pastimes, sleep/rest, home management, work, and eating were rated as being impaired 2‐4 months and also 12 months after treatment. However, the obtained values were spread over a wide range, with large individual differences. Functional limitations were related to more extensive surgery and also to less successful coping.

Conclusion. This study reveals the need of individualized rehabilitation for these patients, and that the SIP and the SOC scale may serve as evaluation tools in a rehabilitation program.
Skull base chondroma of extracranial origin
Authors: Sichel Jean‐Yves , Monteil Jean‐Paul , Elidan Josef
Published: February 2007

Methods. Two cases of chondroma at the skull base, most probably of extracranial origin, are presented: one at the apex of the petrous pyramid and the other in the infratemporal fossa.

Results. In the second case, the surgical findings suggested that the tumor originated in the cartilagineous part of the eustachian tube. The world literature was reviewed and only three cases of extracranial chondromas at the skull base, and ten cases of chondromas of the nasopharynx have been described so far.

Conclusions. The potential origins of chondromas at the skull base are discussed: Cartilagineous remnants at the basisphenoid and basiocciput or the cartilagineous part of the eustachian tube seem to be the most probable origin.
Aneurysmal bone cyst of the zygomatic arch
Authors: Page Edwin L. , Peters Glenn E.
Published: February 2007

Background: Aneurysmal bone cysts are rare vascular lesions that are most commonly found in the long bones. They are rare in the head and neck. Only two prior cases of aneurysmal bone cysts of the zygoma have been reported in the world literature.

Results: We report a case of aneurysmal bone cyst arising in the zygomatic arch with intracranial extension treated with selective arterial embolization and complete excision via an infratemporal fossa approach. This is the first such case reported in the head and neck surgery literature.

Conclusions: Selected cases of aneurysmal bone cyst may be safely treated with selective arterial embolization and complete resection.
Safety of preoperative enoxaparin in head and neck cancer surgery
Authors: Gondret Rémi , Dominici Lionel , Angelard Bruno , Dubos Sylvie , Al‐Rawi Said , Huet Yann , Clergue Francois , Saint‐Guily Jean Lacau
Published: February 2007

Background. Thromboembolism is a risk in major head and neck cancer surgery patients predisposed to thrombosis. This study was designed to determine whether enoxaparin (a low molecular weight heparin) administered prior to surgery induces perioperative bleeding.

Methods. Forty patients scheduled for major cervicofacial cancer surgery were randomized in a double‐blind study to receive either 20 mg enoxaparin or placebo, 12 hours before surgery. Blood losses were measured at the end of surgery and 6 hours later.

Results. Bleeding was equal in the placebo group and in the enoxaparin group, with losses of 648 ± 106 mL and 602 ± 106 mL (p = 0.76), respectively. Six hours after surgery, blood collected was 159.3 ± 25.7 mL in the placebo group vs 151.4 ± 21 mL in the enoxaparin group (p = 0.81).

Conclusion. Preoperative administration of enoxaparin is safe in head and neck cancer surgery, but further studies are required to evaluate its efficacy in preventing thromboembolism. © 1995 Jons Wiley & Sons, Inc.
Linac radiosurgery for locally recurrent nasopharyngeal carcinoma: Rationale and technique
Authors: Buatti John M. , Friedman William A. , Bova Frank J. , Mendenhall William M.
Published: February 2007

Background. Patients with locally recurrent nasopharyngeal carcinoma benefit from reirradiation. A main barrier to successful palliation or cure is dose limitation secondary to normal tissue tolerance. There are many strategies to increase the tolerated dose to the recurrent lesions. Stereotactic radiosurgery for the treatment of these lesions has rarely been reported.

Methods. Three patients with recurrent nasopharyngeal carcinoma were treated with linac‐based stereotactic radiosurgery.

Results. One patient remained disease‐free 1 year after radiosurgery; the second patient had neurologic deterioration of uncertain etiology (complication vs recurrence) 6 months after radiosurgery; and the third patient had local recurrence 6 months after radiosurgery.

Conclusion. Stereotactic radiosurgery can be used to deliver a boost dose of radiation to recurrent nasopharyngeal carcinomas. The technique is increasingly available and may offer some advantages compared with other techniques. Treatment recommendations are presented. © 1995 Jons Wiley & Sons, Inc.
Color doppler imaging for vocal cord palsy
Authors: Ooi London Lucien P. J. , Chan Hsiang Sui , Soo Khee Chee
Published: February 2007

Background. Conventional techniques of laryngoscopy for vocal cord palsy can sometimes be difficult or impossible to perform, and B‐mode real‐time ultrasonography has been previously reported by the authors to be helpful in these situations. In some cases, however, B‐mode ultrasonography can be inconclusive. We investigated whether color Doppler imaging can significantly improve vocal cord examination in these cases.

Method. Ten normal volunteers were examined using the Acuson 128XP/5 with a 7‐MHz L7384 linear transducer. The thyroid cartilage was used as an acoustic window. Several distinct color flow patterns were observed with the subjects breathing quietly at rest, at the start of vocalization, and in prolonged phonation. Eight patients with hoarseness of voice were then examined by two separate observers in a double‐blinded fashion. The first observer performed B‐mode ultrasonography and color Doppler imaging, while the second observer performed indirect laryngoscopy and direct fiberoptic laryngoscopy.

Results. Laryngoscopy was used as the standard for comparison. B‐mode real‐time ultrasonography correctly identified vocal cord palsy in three patients and normal vocal cords in one. The remaining four patients were reported as equivocal or normal. Color Doppler imaging correctly identified the problem in all eight patients.

Conclusion. Color Doppler imaging for vocal cord examination is more sensitive than B‐mode real‐time ultrasonography, and seems to be as accurate as laryngoscopy in determining vocal cord palsy or paresis. © 1995 Jons Wiley & Sons, Inc.
DNA content in adenoid cystic carcinomas
Authors: Franzén Gunnar , Nordgård Ståle , Boysen Morten , Larsen Petter L. , Halvorsen Tore B. , Clausen Ole P. F.
Published: February 2007

Background. A retrospective study was performed on 51 patients with adenoid cystic carcinomas to see whether DNA ploidy, tumor stage, and histopathologic grading correlated with prognosis.

Methods. Histopathologic grading was performed according to Szanto et al and DNA content was estimated from archived material using the technique by Hedley et al.

Results. Thirty‐nine tumors were DNA diploid and 12 were DNA aneuploid. Histologic grade III was more often associated with DNA aneuploidy than the lower grades (p = 0.011). DNA ploidy also correlated with clinical stage (p = 0.011). Log‐rank analysis and Cox regression analysis of treatment failures revealed significant findings for S‐phase value and DNA ploidy.

Conclusions. Our results indicate that DNA ploidy estimations, S‐phase value, and histologic grading are prognostic factors in adenoid cystic carcinomas. These examinations should therefore be incorporated in the evaluation of patients with adenoid cystic carcinomas. © 1995 Jons Wiley & Sons, Inc.
In situ skin grafting of free muscle flaps prior to microvascular transfer to provide intraoral lining for full‐thickness defects
Authors: Netscher David T. , Wigoda Paul , Alford Eugene L.
Published: February 2007

Background. Previously, the importance of providing skin for intraoral lining for full‐thickness mucocutaneous defects has been emphasized. More recently, simple skin grafting of the intraoral portion of muscle flaps has been described.

Methods. Six patients were evaluated who had full‐thickness mucocutaneous defects reconstructed by means of free muscle flaps with skin grafting of the intraoral muscle surface. An illustrative case is provided. A technique of preplacing the skin graft on the muscle prior to microvascular transfer is described. Mucosal biopsies were performed at the reconstruction site.

Results. All patients had complete take of the skin grafts. No fistulas occurred. Functional and esthetic results were satisfactory.

Conclusions. The ideal candidate for this form of reconstruction is one in whom there is a large, full‐thickness mucocutaneous defect. Preplacement of the skin graft reduces ischemia time, allows suturing of the skin graft to the muscle surface outside the narrow confines of the oral cavity, and enables placement of multiple quilting sutures that secure the graft against shear forces and so obviate the need for a stent dressing. © 1995 Jons Wiley & Sons, Inc.
Kaposi's sarcoma of the oral cavity in a non‐aids patient: Case report and review of the literature
Authors: Jindal Jay R. , Campbell Bruce H. , Ward Timothy O. , Almagro Urias S.
Published: February 2007

Background. Not every patient with Kaposi's sarcoma (KS) has acquired immunodeficiency syndrome (AIDS). The “classic” form of KS is rare, and is associated with an indolent course. It is very distinct from AIDS‐associated KS in which oral involvement is common and may be the initial presenting feature of this disease. Two other types of KS are recognized, the African and renal transplant‐associated, which also are rarely associated with oral involvement.

Methods. We present the case of a 76‐year‐old man of Mediterranean ancestry who was found to have a biopsyproven classical KS lesion of the hard palate. The patient was followed by the Radiation Therapy and Otolaryngology Services during and after his treatment. A review of the literature was also conducted.

Results. Radiotherapy was ineffective at a dose considered “standard” for KS in AIDS patients (1,500 cGy), but was effective when continued to 4,800 cGy. A 24‐month follow‐up showed no evidence of recurrence in the oral cavity.

Conclusions. KS of the oral cavity, is almost always associated with AIDS in the United States, However, it can occur in any of the four types of KS. Although this neoplasm is typically highly radiosensitive, the treatment for each patient needs to be individualized. © 1995 Jons Wiley & Sons, Inc.
Cytogenetic analysis of tissues from patients with familial paragangliomas of the head and neck
Authors: Zaslav Ann‐Leslie , Myssiorek David , Mucia Christina , Fox Joyce E.
Published: February 2007

Background. Paragangliomas of the head and neck are slow‐growing tumors that originate from neural crest cells. Between 7% and 9% of these tumors have a familial occurrence. The suspected gene for familial paragangliomas (FP) is transmitted with an autosomal dominant mode of inheritance with incomplete penetrance, and appears to exhibit genomic imprinting. It has been demonstrated by family studies that individuals who inherit the gene(s) from their father will develop the disease. Through linkage analysis, the gene(s) for FP has been postulated to be located on the long arm of chromosome 11. The discovery of many different genes has been elucidated through the cytogenetic analysis of affected individuals who carry specific chromosome aberrations. This project was designed to look for chromosome abnormalities in several second‐generation family members to further assist in the localization of the gene(s) for FP.

Methods. This study involved the cytogenetic evaluation of lymphocytes, fibroblasts, and tumor cells of several second‐generation family members from a three‐generation family with FP of the head and neck to look for chromosome abnormalities generally, and for abnormalities of chromosome 11 specifically. Standard cytogenetic techniques were used for lymphocyte and fibroblast cultures. Tumor cells were cultured in a collagen matrix with F12 medium supplemented with 3% L‐glutamine and 10% fetal calf serum.

Results. There were no detectable abnormalities of chromosome 11 in any of the cells. However, nonrandom abnormalities of chromosomes 5 and 7 were seen in some of the tumor cells of one FP patient. To our knowledge, this is the first article which demonstrated the ability to successfully culture FP of the head and neck. © 1995 Jons Wiley & Sons, Inc.
Papillary thyroid carcinoma mistaken for malignant melanoma: Pitfalls in diagnosis
Authors: Orloff Lisa A. , Weymuller Ernest A. , Flaherty Michael J.
Published: February 2007

Background. Immunohistochemical methods and aspiration cytology are used with increasing frequency in the diagnosis of head and neck histopathology. Magnetic resonance imaging is also gaining popularity as a diagnostic tool.

Methods. We report a case of papillary thyroid carcinoma which was initially misdiagnosed as malignant melanoma due to several confounding diagnostic test results.

Results. False‐positive immunostaining of a cytologic preparation with a commercial preparation of HMB45 melanoma stain and characteristic MRI findings contributed to the erroneous diagnosis of malignant melanoma.

Conclusions. Potential pitfalls in test interpretation are discussed, and recommendations for the judicious use of immunostaining, MRI, and other diagnostic studies are presented. © 1995 Jons Wiley & Sons, Inc.
Adenocarcinoma of the ethmoid sinus
Authors: Wax Mark K. , Yun K. John , Wetmore Stephen J. , Lu Xiangping , Kaufman Howard H.
Published: February 2007

Background. Carcinoma of the paranasal sinuses is rare. The majority of these originate in the maxillary sinus with primary ethmoid carcinomas occurring in up to 20% of cases. Adenocarcinomas comprise up to 50% of the ethmoid malignancy. The relative rarity of tumors originating in this area has led to their inclusion in series that consist mainly of maxillary antral tumors.

Methods. A retrospective chart review of all patients presenting with primary ethmoid adenocarcinoma at West Virginia University Hospitals between 1988 and 1993 was undertaken. Only patients whose epicenter was believed to be in the ethmoids were included in this analysis. CT scans, MRIs, operative notes, pathology, and final outcome were all analyzed.

Results. Eight patients with primary ethmoid adenocarcinoma were treated during this time span. The male to female ratio was 1:1 with a mean age of 50 years. Symptoms had been present from 3 to 18 months (mean 8 months). All patients underwent craniofacial resection with 5 patients receiving postoperative radiotherapy. Pathologically 4 patients had cribriform plate erosion, 2 had dural involvement, and 1 had extension into the sphenoid sinus. With a mean follow‐up of 45 months (9–71 months) 7 patients are disease free and 1 patient has died of disease.

Conclusions. Obtaining clear margins by craniofacial resection is essential to the management of adenocarcinoma of the ethmoid sinuses. Radiotherapy is reserved for positive margins, cribriform plate penetration, dural invasion, and high‐grade lesions that are close to the cribriform plate. Local control was obtained in 87% of our patients. © 1995 Jons Wiley & Sons, Inc.
Tumor angiogenesis and prognosis in squamous cell carcinoma of the head and neck
Authors: Zätterström Ulf K. , Brun Eva , Willén Roger , Kjellén Elisabeth , Wennerberg Johan
Published: February 2007

Background. The progression of tumor growth requires the recruitment of new blood vessels. It has been suggested that the degree of neovascularization would correlate with clinical prognosis. The purpose of the present study was to ascertain whether tumor vascularization correlated with clinical outcome in cases of primary squamous cell carcinoma of the head and neck (SCCHN).

Methods. In tumor biopsies from 48 patients, microvessel density was determined by immunohistochemistry based on polyclonal antibodies against factor VIII related endothelial antigen. Computerized image analysis was used to evaluate the staining intensity per histologic area. The degree of staining was quantitated and expressed as microvessel density, low and high microvessel density subgroups being compared with regard to survival.

Results. Median survival was 10 months in the subgroup with very low microvessel density scores, as contrasted to 69 months in the remainder with high scores (p = 0.08). Neither the patient's age, TNM status, clinical stage, nor histologic grade was related to microvessel density. Among the patients who eventually died of SCCHN (n = 23), there was a subgroup of patients with complete response to radiotherapy. This subgroup had significantly higher microvessel density and longer survival than did the patients who responded poorly or not at all to radiotherapy.

Conclusion. The findings suggest that in SCCHN the degree of vascularization might be used as a predictor of response to radiotherapy. © 1995 Jons Wiley & Sons, Inc.
Trends in the use of tracheotomy in the pediatric patient: The Iowa experience
Authors: Palmer Phyllis M. , Dutton Jay M. , McCulloch Timothy M. , Smith Richard J. H.
Published: February 2007

Background. The role of tracheotomy in airway management in children has been widely discussed. Improved medical care and technology have resulted in improved survival rates, and increased survival rates have been associated with changes in the indications for and the use of tracheotomy. The purpose of this review was to evaluate trends in the use of tracheotomy over a 15‐year period.

Methods. We reviewed the medical charts of patients who underwent tracheotomy from 1975 to 1989 and analyzed them over three 5‐year time intervals: Block 1, 1975–79; Block 2, 1980–84; and Block 3, 1985–89.

Results. In the defined age group, 305 patients underwent tracheotomy during the study period. Records from 281 patients were analyzed; the remaining charts either were unavailable for review or did not contain adequate documentation of the tracheotomy. We observed an increase in the number of tracheotomies over time, especially in the younger population. Across blocks, median age decreased, duration of tracheotomy increased, and indications for tracheotomy changed.

Conclusions. Mean age, duration of tracheotomy, and indications for tracheotomy changed over the 15‐year period. Additionally, these parameters were strongly related. © 1995 Jons Wiley & Sons, Inc.
Timing of glottic closure during normal swallow
Authors: Ohmae Yukio , Logemann Jeri A. , Kaiser Peter , Hanson David G. , Kahrilas Peter J.
Published: February 2007

Background. The purpose of this study was to determine the temporal characteristics and patterns of glottic closure during normal swallow using concurrent videofluoroscopy and videoendoscopy.

Methods. Three swallows each of four bolus types were examined in eight healthy volunteers with the endoscope in two positions: at the level of the uvula and at the laryngeal vestibule. Data analysis compared: (1) temporal relationships between laryngeal behaviors and oropharyngeal swallow events and (2) airway conditions at the time of key oropharyngeal events.

Results. Although arytenoid adduction and subsequent arytenoid contact occurred as one of the initial events during swallow, the timing of these events was highly variable. On the other hand, true vocal cord (TVC) closure occurred mainly after the onset of laryngeal elevation, and it was affected by bolus volume.

Conclusions. In normal swallow, arytenoid closure did not always mean complete TVC closure, and complete TVC closure might be accomplished during the process of laryngeal elevation and arytenoid tilting.
Elevated carcinoembryonic antigen levels correlating with disease recurrence in a patient with adenoid cystic carcinoma
Authors: Kuhel William I. , Chow Harold , Godwin Thomas A. , Minick C. Richard , Libby Daniel M.
Published: February 2007

Background. Carcinoembryonic antigen (CEA) is an oncofetal glycoprotein involved in cell recognition and adhesion. Serum CEA has been extensively studied as a potential chemical marker for malignancy, most notably in patients with colon carcinoma. Serum CEA measurements have not been reported for patients with salivary gland carcinomas.

Methods. Serum CEA was measured in a case study using enzyme immunoassay with monoclonal antibody specific for CEA. Tissue was examined with standard histologic and immunohistologic methods.

Results. A patient was initially seen with adenoid cystic carcinoma (ACC) of the trachea and had a markedly elevated serum CEA level which declined after surgical resection. The serum CEA level became elevated again when the patient developed abdominal metastases and then declined after debulking of the tumor. Immunohistochemical study of the tumor was positive for CEA.

Conclusions. The measurement of serum CEA levels may play a role in the management of patients with ACC. Clinical investigation utilizing monoclonal antibodies against CEA, for imaging and for the delivery of chemotherapy and radiotherapy may be worthwhile. © 1995 Jons Wiley & Sons, Inc.
Lymphoepithelial carcinoma of the parotid gland
Authors: Kountakis Stilianos E. , Soohoo Wilson , Maillard Alberto
Published: February 2007

Background. Primary lymphoepithelial carcinoma of the parotid gland is a rare tumor with an increased incidence among Eskimos and Orientals. We reviewed our experience with parotid lymphoepithelial carcinoma and investigated its pathophysiology and possible association with Epstein‐Barr virus.

Methods. We performed a retrospective review of records of patients diagnosed with lymphoepithelial carcinoma of the parotid gland.

Results. We identified two women of Hispanic origin diagnosed with primary lymphoepithelial carcinoma of the parotid gland. In one of the cases, the carcinoma was intimately associated with a benign lymphoepithelial lesion. In both cases, there was no demonstration of Epstein‐Barr virus.

Conclusion. Primary lymphoepithelial carcinoma of the parotid gland may arise from malignant transformation of a benign lymphoepithelial lesion. © 1995 Jons Wiley & Sons, Inc.
Role of epstein‐barr virus in fine‐needle aspirates of metastatic neck nodes in the diagnosis of nasopharyngeal carcinoma
Authors: Macdonald Michael R. , Freeman Jeremy L. , Hui May F. , Cheung Roy K. , Warde Padraig , McLvor Nicholas P. , Irish Jonathan , Dosch Hans‐Michael
Published: February 2007

Background. The patient with nasopharyngeal carcinoma (NPC) frequently is initially seen with regional node dissemination. Preliminary investigations suggest that the presence of Epstein‐Barr virus (EBV) genomes in neck metastases from an occult primary may be diagnostic and predictive of NPC. The goal of this study was to test this proposition.

Methods. The polymerase chain reaction (PCR) was used to detect the presence of EBV DNA in fine‐needle aspirate (FNA) samples obtained from malignant neck nodes. Control samples were obtained from other locations in the head and neck.

Patients. The patients in this study were evaluated at the Toronto Princess Margaret Hospital, a province‐wide tertiary care cancer treatment center. Of the 23 patients evaluated with malignant neck masses, 6 had NPC, 5 patients had metastatic squamous cell carcinoma of an unknown primary, and 12 patients served as controls with other known head and neck carcinomas. One of the patients initially diagnosed as an unknown primary later demonstrated NPC. FNA specimens were also obtained from 24 normal parotid, submandibular, or thyroid glands for comparison.

Results. In the samples with sufficient DNA for analysis, EBV was detected in 5 of 5 neck nodes from patients with known NPC. EBV was also detected in the neck node of a patient who went on to develop NPC and in a cervical node from 1 of 2 patients in whom the primary tumor remained unknown. None of the evaluable control neck nodes or FNA controls from other sites demonstrated EBV.

Conclusions. These results demonstrate the utility of NPC‐diagnostic EBV gene amplification in FNA samples of neck metastases and suggest that the presence of the EBV genome in FNA samples of neck nodes is predictive of the presence of NPC. © 1995 Jons Wiley & Sons, Inc.
Gene therapy for head and neck cancer
Authors: Clayman Gary L.
Published: February 2007

Background. Molecular or gene therapy involves the introduction of genetic material (DNA) into host cells to induce the expression of the therapeutic product of that gene. This ability to transfer genetic material provides a novel approach for the investigation and potential treatment of a variety of both inherited and acquired diseases.

Methods. This review summarizes the principles of molecular therapy and potential strategies for its use in the treatment of solid malignancies. Some molecular therapy strategies permanently integrate the gene into the targeted cells, whereas others induce only transient expression of a therapeutic gene product. Initial clinical studies in gene therapy are being closely regulated for public safety by both the National Institutes of Health Recombinant DNA Advisory Committee and the U.S. Food and Drug Administration.

Conclusions. These studies will provide insight into further applications of gene therapy and novel molecular interventions that may alter our management of solid malignancies; they may also reveal mechanisms for preventing or reversing the carcinogenic process.
Switching between “On” and “Off” states of persistent activity in lateral entorhinal layer III neurons
Authors: Tahvildari Babak , Fransén Erik , Alonso Angel A. , Hasselmo Michael E.
Published: February 2007

Persistent neural spiking maintains information during a working memory task when a stimulus is no longer present. During retention, this activity needs to be stable to distractors. More importantly, when retention is no longer relevant, cessation of the activity is necessary to enable processing and retention of subsequent information. Here, by means of intracellular recording with sharp microelectrode in in vitro rat brain slices, we demonstrate that single principal layer III neurons of the lateral entorhinal cortex (EC) generate persistent spiking activity with a novel ability to reliably toggle between spiking activity and a silent state. Our data indicates that in the presence of muscarinic receptor activation, persistent activity following an excitatory input may be induced and that a subsequent excitatory input can terminate this activity and cause the neuron to return to a silent state. Moreover, application of inhibitory hyperpolarizing stimuli is neither able to decrease the frequency of the persistent activity nor terminate it. The persistent activity can also be initiated and terminated by synchronized synaptic stimuli of layer II/III of the perirhinal cortex. The neuronal ability to switch “On” and “Off” persistent activity may facilitate the concurrent representation of temporally segregated information arriving in the EC and being directed toward the hippocampus. © 2007 Wiley‐Liss, Inc.
Absence of SV40 antibodies or DNA fragments in prediagnostic mesothelioma serum samples
Authors: Kjærheim Kristina , Røe Oluf Dimitri , Waterboer Tim , Sehr Peter , Rizk Raeda , Dai Hong Yan , Sandeck Helmut , Larsson Erik , Andersen Aage , Boffetta Paolo , Pawlita Michael
Published: February 2007

The rhesus monkey virus Simian Virus 40 (SV40) is a member of the polyomavirus family. It was introduced inadvertently to human populations through contaminated polio vaccine during the years 1956–1963, can induce experimental tumors in animals and transform human cells in culture. SV40 DNA has been identified in mesothelioma and other human tumors in some but not all studies. We tested prediagnostic sera from 49 mesothelioma cases and 147 matched controls for antibodies against the viral capsid protein VP1 and the large T antigen of SV40 and of the closely related human polyomaviruses BK and JC, and for SV40 DNA. Cases and controls were identified among donors to the Janus Serum Bank, which was linked to the Cancer Registry of Norway. Antibodies were analyzed by recently developed multiplex serology based on recombinantly expressed fusions of glutathione‐S transferase with viral proteins as antigens combined with fluorescent bead technology. BKV and JCV specific antibodies cross‐ reactive with SV40 were preabsorbed with the respective VP1 proteins. Sera showing SV40 reactivity after preabsorption with BKV and JCV VP1 were further analyzed in SV40 neutralization assays. SV40 DNA was analyzed by SV40 specific polymerase chain reactions. The odds ratio for being a case when tested positive for SV40 VP1 in the antibody capture assay was 1.5 (95% CI 0.6–3.7) and 2.0 (95% CI 0.6–7.0) when only strongly reactive sera where counted as positive. Although some sera could neutralize SV40, preabsorption with BKV and JCV VP1 showed for all such sera that this neutralizing activity was due to cross‐reacting antibodies and did not represent truly SV40‐specific antibodies. No viral DNA was found in the sera. No significant association between SV40 antibody response in prediagnostic sera and risk of mesothelioma was seen. © 2007 Wiley‐Liss, Inc.
Separation of platelet‐rich plasma by modified centrifugal elutriation
Authors: Persidsky Maxim D. , Ling Nan‐Sing
Published: February 2007

The Beckman centrifugal elutriation (CE) system is modified for the separation of platelet‐rich plasma (PRP) from human and rabbit blood. The Beckman separation chamber is found inadequate for this purpose, and a new chamber of conical shape has been developed. Optimal flow rate for separating PRP from whole blood with the new chamber of 11.3 ml capacity is 3.5 ml/min while centrifuging at 2500 rpm or 700g. Collection process takes about 4 minutes. This new process is based on the principle of centrifugal counterflow displacement and filtration, and is different from the CE process which is based on counterflow centrifugation and differential elution. About 90% of total platelets are recovered with this new process. The collected samples are free of leucocytes and contained only a few erythrocytes. Platelets collected by either differential centrifugation (DC) or new procedures are found to be similar in morphological characteristics, both being discoidal. Other characteristics such as aggregation response induced by ADP or epinephrine, serotonic‐14C secretion, and survival of autologous platelets in rabbits are also found to be similar. However, ATP release induced by ADP is consistently higher from platelets prepared by our procedure than from those prepared by the DC procedure.
The historical development of automated hemapheresis
Authors: Millward Bruce L. , Hoeltge Gerald A.
Published: February 2007

Many studies in the early twentieth century involved attempts to separate white blood cells from whole blood for further examination and experimentation as well as for the treatment of neutropenic patients. In the 1950s, the need to use blood and its derivatives efficiently produced the first apparatus to separate blood continuously in a closed system. The prototypes of present‐day continuous flow blood cell separators were developed in the 1960s.
Review: Deficiencies in the neutrophil system of newborn infants, and the use of leukocyte transfusions in the treatment of neonatal sepsis
Authors: Christensen Robert D. , Anstall Harold S. , Rothstein Gerald
Published: February 2007

Bacterial sepsis is a major cause of morbidity and mortality in the neonatal period. Deficiencies in neutrophil chemotaxis, phagocytosis, and bacterial killing have all been proposed as factors possibly responsible for this problem. In addition, the neutrophil storage pool, or all segmented neutrophils, band neutrophils, and meramyelocytes/kg body weight stored within the marrow, appears to be very small in neonates compared to that in adults, and when an infection develops in a neonate, neutrophil production from stem cells may be limited. In this paper we review the evidence for these neonatal neutrophil deficiencies and examine the animal and clinical studies which have tested leukocyte transfusion as a possible adjunctive therapeutic modality for sepsis neonatorum.
Childhood chronic relapsing polyneuropathy: Dramatic improvement following plasmapheresis
Authors: Connor R. Kevin , Ziter Fred A. , Anstall Harold B.
Published: February 2007

We present clinical data on two boys with chronic relapsing polyneuropathy. Their recurrent episodes of weakness had produced marked disability which was unresponsive to continuous prednisone therapy. Plasmapheresis produced dramatic improvement in muscle strength and functional ability. The remissions induced have been sustained despite withdrawal of steroid therapy.
Immune globulin intravenous replacement after plasma exchange
Authors: Dau Peter C.
Published: February 2007

The infusion of high‐dose (275 mg/kg body weight) immune globulin intravenous (IGIV) after 466 plasma exchanges in 64 patients with autoimmune disease was studied. Side effects occurred during 15% of IGIV infusions. For the most part they were transient and mild, and could be controlled by slowing the infusion rate. Two percent of infusions had to be terminated because of more persistent or severe side effects. Chills were the most common side effect, followed by nausea, flushing, anxiety, and nausea. Serum IgG levels were immediately restored into the normal range by IGIV infusions, and they were much more effective in restoring IgG levels after plasma exchange than intramuscular injection of 9.9 g of immune serum globulin (ISG). Up to 15 weekly high‐dose IGIV infusions were well tolerated without unusual side effects. These patients did not have any major bacterial infections, but were not protected from developing Herpes zoster at the dosages used. In patients with myasthenia gravis, a short term impact of a single IGIV infusion on titers of antibody to acetylcholine receptor could not be demonstrated. This study showed IGIV to be a safe and effective preparation for the replacement of normal IgG removed during plasma exchange.