bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of intraoperative rupture of pleomorphic adenomas to recurrence: An 11‐25 year follow‐up study
Authors: Natvig Ketil , Søberg Randulf
Published: February 2007

Background. Intraoperative rupture of the capsule of a pleomorphic adenoma is reported to be associated with an increased recurrence rate. For many years, we have noted few recurrences among patients who experienced rupture of the capsule during surgery. Therefore, we asked “How often has surgical rupture of the capsule of a mixed parotid tumor resulted in recurrence among our patients?” This study is a summary of our clinical observations and not a methodologic one.

Methods. The medical records of 346 patients operated on between 1965 and 1981 were reviewed. The surgical notes and histopathologic descriptions were examined with special reference to the relationship between surgical margins and tumor capsule. Satisfactory follow‐up was obtained from 238 patients primarily operated on in our department. The average observation time was 18 years. None of our patients received postoperative irradiation.

Results. Six (2.5%) patients had a recurrence 7 to 18 years postoperatively (mean 11.8 years). This recurrence rate is of the same order of magnitude as other reports. Rupture of the capsule with macroscopic spillage of tumor cells occurred in 26 patients and two (8%) of them developed recurrent tumors. Surgical dissection close to the capsule was performed in 87 cases, with one recurrence. In the remaining 121 patients the surgical dissections were done without visualizing the tumor capsule. Three (2.5%) of these cases developed recurrent tumor. The 8% recurrence rate after capsule rupture is not statistically different from the 2% for the other patients. There was also no difference in recurrence rate between patients with microscopic positive or negative surgical resection margins.

Conclusions. We question whether spillage of tumor cells from a pleomorphic adenoma plays such an important role in the development of recurrent tumors as has been previously postulated. We also question the justification and benefit of postoperative radiotherapy for patients with this benign disease. © 1994 John Wiley & Sons, Inc.
Fibrous neoplasms of the adult larynx
Authors: Rohn Gregory N. , Close Lanny G. , Vuitch Frank , Merkel Marie A.
Published: February 2007

Fibrous neoplasms of the adult larynx are uncommon and can be benign, locally aggressive, or malignant. From January 1, 1987 to December 31, 1991, 189 adult patients underwent partial or total laryngectomy for laryngeal neoplasms at the University of Texas Southwestern Medical Center‐affiliated hospitals. During this period, three (1.6%) patients were treated for fibrous neoplasms of the larynx. All three lesions arose in the true vocal fold. In one patient, a local recurrence within 6 months following partial laryngeal resection necessitated total laryngectomy. All three patients are alive and disease‐free 1 to 4 years following definitive surgery. We present these cases and discuss computed tomographic (CT), histopathologic, and electron microscopic (EM) findings. Based on this experience, surgical treatment of these lesions is recommended, the extent of which is guided by clinical, radiologic, and pathologic evaluation. © 1994 John Wiley & Sons, Inc.
DNA measurements for monitoring chemotherapy in advanced head and neck carcinomas
Authors: Welkoborsky Hans J. , Mann Wolf J. , Sanal Cem , Freije James E.
Published: February 2007

Background. Quantitative DNA measurements have demonstrated prognostic relevance in various malignancies, including head and neck cancer. The application of DNA measurements in monitoring and predicting the outcome of chemotherapy in treating patients with head and neck cancer was investigated.

Methods. Twenty‐five patients with advanced squamous cell carcinomas of the head and neck who underwent primary chemotherapy with three courses of cisplatin and 5‐fluorouracil (5‐FU) were examined in this study. Cytologic smears from the tumor site, as well as from normal mucosa, were taken before and 1 week after each course of chemotherapy. Quantitative DNA measurements were performed using an automatic microscope and a TV‐based image analysis system. The DNA parameters (ie, mean DNA content of the tumor cells, 2c deviation index (2c Dl), 5c exceeding rate (5c ER), DNA malignancy grade, and stemline analysis) were determined from the single cell measurements.

Results. Tumors which responded to chemotherapy showed a shift of the mean DNA content and stemline towards euploidy and a decrease of aneuploid tumor cells with a DNA content of more than 5c. Tumors which did not respond to chemotherapy showed a persistent high percentage of aneuploid tumor cells and a high malignancy grade. These changes in the DNA content were observed after the first course of chemotherapy. In a clinical follow‐up, patients with a shift of the DNA data towards euploidy during chemotherapy showed a significant longer recurrence‐free interval than patients with residual aneuploid cell clones.

Conclusions. Quantitative DNA measurements appear to be useful in monitoring therapy and to predict the outcome after chemotherapy. Although no typical constellation was found which predicts good or bad response, the DNA data suggest that changes in the data after the first course of chemotherapy may correlate with outcome. © 1994 John Wiley & Sons, Inc.
Swallow recovery in an oral cancer patient following surgery, radiotherapy, and hyperthermia
Authors: Lazarus Cathy L. , Logemann Jeri A. , Kahrilas Peter J. , Mittal Bharat B.
Published: February 2007

Background. No study has examined the nature and extent of swallowing impairment in oral cancer patients following treatment with combined hyperthermia and interstitial radiotherapy. Few studies have examined the effects of voluntary swallow maneuvers (supersupraglottic and Mendelsohn) on pharyngeal phase swallowing in the oral cancer patient treated with surgery or radiotherapy. This study examined the effects of combined radiotherapeutic salvage treatments of hyperthermia and interstitial implantation and swallow recovery using swallow maneuvers in a surgically treated and irradiated oral cancer patient.

Methods. The patient under study, a 51‐year‐old man, underwent radiotherapy, according to Radiation Therapy Oncology Group (RTOG) protocol #8419, consisting of a combination of interstitial irradiation and hyperthermia to the base of tongue, for a recurrent squamous cell cancer. He underwent videofluorographic (VFG) examination of his swallowing, a modified barium swallow at three time points: 2 days following radiotherapy treatment (VFG1), 4 weeks later (VFG2), and 8 months later (VFG3). Temporal and biomechanical analyses of swallows were performed at each time point.

Results. Swallow maneuvers and time resulted in improved laryngeal elevation and laryngeal vestibule closure during the swallows on VFG2. Maximum upper esophageal sphincter (UES) opening width and duration were more normal. Fewer swallows were required for bolus clearance through the pharynx. Base of tongue tissue necrosis occurred as a complication of radiotherapy between VFG2 and VFG3, with resultant severe reduction in posterior movement of the tongue base, incomplete tongue base contact to the posterior pharyngeal wall, reduced laryngeal elevation, and incomplete laryngeal vestibule closure during swallowing at VFG3. UES opening became less normal and a greater number of swallows were required for bolus clearance through the pharynx.

Conclusions. Combined interstitial irradiation and hyperthermia can cause oropharyngeal swallowing problems. Time and swallow therapy can improve these swallow disorders. Tongue base tissue necrosis can cause further swallow impairment, emphasizing the importance of the tongue base in normal deglutition. Further studies are needed to examine the impact of combined hyperthermia and interstitial implantation for treatment of tongue base tumors on swallow functioning in a larger group of patients. © 1994 John Wiley & Sons, Inc.
Bone marrow metastases from small cell cancer of the head and neck
Authors: Pierce Scott T. , Cibull Michael L. , Metcalfe Monty S. , Sloan David
Published: February 2007

Background. Primary small cell carcinoma of the head and neck is rare. Although the larynx is the most prevalent site of head and neck small cell carcinoma (SCC), this report will concentrate on SCC of the major salivary glands and paranasal sinuses. In all, 33 cases of paranasal sinus and 43 cases of major salivary gland SCC have been reported in the literature.

Methods. We report two patients, one with submandibular gland SCC and the other with maxillary sinus SCC.

A literature review of all known paranasal sinus and major salivary gland SCC with inclusion of data from these two new cases is undertaken. Discussion of all past and present cases concentrates on sites of metastasis, treatment, and survival.

Results. Paranasal sinus SCCs predominantly arise from the nasal cavity, whereas the parotid gland is the primary site in three fourths of major salivary gland SCCs. One half of major salivary gland and three fourths of paranasal sinus SCCs have only local disease at presentation. Both patients in this report developed bone marrow metastases, a feature heretofore not observed in SCC from these primary sites. The patient with maxillary sinus SCC developed the syndrome of inappropriate antidiuretic hormone (SIADH).

Conclusion. The paranasal sinus and major salivary glands are rare primary sites for SCCs. Long‐term survival with local therapy in patients with local disease can occur, but in patients with metastatic disease survival mirrors metastatic pulmonary SCC. © 1994 John Wiley & Sons, Inc.
Analysis of methods for nasal tip reconstruction
Authors: Klingensmith Mark R. , Millman Brad , Foster Wayne P.
Published: February 2007

Background. Numerous traditional and contemporary methods for nasal reconstruction are used today. Our investigation qualitatively analyzed different methods of nasal tip reconstruction which led to the development of an algorithm for repair based on the size, depth, and location of tissue loss.

Methods. A case series of 165 nasal tip reconstructions performed during a 2‐year period followed for at least 6 months was critically analyzed with photographic documentation.

Results. Different methods of reconstruction exhibited varying aesthetic results. Analysis of surgical reconstructions led to the development of an algorithm based on the area of tissue defect.

Conclusions. An algorithm was developed for nasal tip reconstructions based on the size and location of tissue defect. Both the recipient and donor sites were analyzed for aesthetic result and complications. © 1994 John Wiley & Sons, Inc.
Fusobacterium pneumonia and death following uvulo‐palato‐pharyngoplasty
Authors: Paaske Peter B. , Rasmussen Birthe M. , Illum Peter
Published: February 2007

A case with a fatal outcome caused by infection with Fusobacterium species was seen in a patient recently operated on for heavy snoring with uvulo‐palato‐pharyngoplasty (UPPP). The mechanism of infection is discussed. It is concluded that a febrile episode seen in patients less than 2 weeks postoperatively should be considered a serious symptom and be treated intensively after thorough examination. © 1994 John Wiley & Sons, Inc.
Plasma cell granuloma of the temporal bone: A case report
Authors: Nam Boo Hyun , Rha Ki Sang , Yoo Jang Yuorl , Park Chan Ii
Published: February 2007

Background. Plasma cell granuloma is a rare benign lesion which is found most frequently in the lungs, and a few cases have been described in the head and neck. In the middle ear and mastoid, a case of plasma cell granuloma was reported by Benton et al.

Methods and Results. A 24‐year‐old woman was seen with a 7‐month history of otalgia and decreased hearing. A computed tomographic (CT) scan showed a soft tissue mass occupying most of the mastoid bone. The mass and the contiguous dura were enhanced homogeneously on magnetic resonance imaging (MRI) scan. Microscopic examination showed plasma cell aggregates mixed with other inflammatory cells and Russell's bodies in a fibrous stroma. Immunoperoxidase studies revealed intracytoplasmic kappa and lambda light chains, and the lesion was confirmed as nonneoplastic and of polyclonal origin (ie, plasma cell granuloma). The patient was treated with conservative surgical excision (a canal‐down mastoidectomy) and postoperative radiotherapy (5,040 cGy in 28 fractions) and remains free of disease 1 year after treatment.

Conclusions. A case of plasma cell granuloma is reported, and we believe this is the second case report of plasma cell granuloma affecting the temporal bone. © 1994 John Wiley & Sons, Inc.
Follicular carcinoma of the thyroid
Authors: Segal Karl , Arad Avigail , Lubin Ernesto , Shpitzer Thomas , Hadar Tuvia , Feinmesser Raphael
Published: February 2007

Background. Follicular carcinomas of the thyroid are less common than papillary carcinomas of the thyroid, and the available data on prognostic factors are relatively scant. A retrospective study covering four decades was undertaken to evaluate clinical and pathologic findings with regard to their effect on prognosis.

Methods. In 195 cases of follicular carcinoma treated from 1954 to 1991 age, sex, histologic type (minimally invasive vs. widely invasive), tumor size, and local, regional, and distant spread as well as the contribution of treatment to survival were evaluated in relation to prognosis.

Results. Age was a significant prognostic factor: there was 100% survival of patients younger than 20 years of age at diagnosis and only one death in the 20‐39 year age group. Sex was not a significant prognostic factor, although there was a tendency to a better prognosis in females. Tumor size was significant, more than 6 cm having a poor prognosis. Blood vessel invasion influenced prognosis for the first 10 years. The presence of distant metastases was significant regarding survival. Lymph node involvement had a negative effect on the outcome.

Conclusions. The factors of age, tumor size, invasion of blood vessels, and distant metastases are significant predictors of survival for patients with follicular carcinoma, whereas sex is not; regional spread needs to be evaluated further. © 1994 John Wiley & Sons, Inc.
Tongue flaps for reconstruction of the oral cavity
Authors: Díaz Francisco J. , Dean Alicia , Alamillos Francisco J. , Naval Luis , Fernández Jacinto , Monje Florencio
Published: February 2007

Pedicled tongue flaps (anterior, posterior, double) have proved to be an effective method of repairing defects due to tissue loss in the oral cavity. Their central position, mobility, and excellent blood supply make the use of these flaps feasible in a variety of sites.
Undifferentiated nasopharyngeal carcinoma presenting as a parotid mass
Authors: Wanamaker John R. , Kraus Dennis H. , Biscotti Charles V. , Eliachar Isaac
Published: February 2007

Background. Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of cases it may present with serous otitis or cervical metastases. Although the metastases usually occur in the neck, the lymphatic network of the parotid may also serve as a site for the metastatic deposits. We present a case in which the initial manifestation of nasopharyngeal carcinoma of the lymphoepithelioma type was a parotid mass.

Methods. Case study.

Results. A patient who was initially seen with an isolated parotid mass was found to have an undifferentiated carcinoma of the lymphoepithelial type. Further evaluation identified an occult nasopharyngeal carcinoma, and the patient underwent radiotherapy.

Conclusions. A diagnosis of a malignant lymphoepithelial lesion of the parotid gland or undifferentiated carcinoma of the lymphoepithelial type mandates a search for an occult primary nasopharyngeal tumor.
Superior laryngeal nerve injury from thyroid surgery
Authors: Teitelbaum Benjamin J. , Wenig Barry L.
Published: February 2007

Background. Injury to the recurrent laryngeal nerve is a well‐recognized complication of thyroid surgery. Injury to the superior laryngeal nerve is less documented, perhaps due to the difficulty in recognizing its manifestations. This study was designed to document the incidence of injury to the superior laryngeal nerve in a series of patients who underwent thyroidectomy.

Methods. Twenty consecutive patients with thyroidectomy during a 9‐month period underwent evaluation for superior laryngeal nerve injury 3 months postoperatively. Methods for evaluation included laryngeal videostroboscopy, laryngeal electromyography, and a subjective interview.

Results. One patient (5%) was diagnosed with unilateral superior laryngeal nerve injury.

Conclusions. The risk of injury to the superior laryngeal nerve during thyroidectomy is significant, and the result may be devastating to those patients who rely on their voices professionally. Laryngeal videostroboscopy and electromyography may be necessary to diagnose superior laryngeal nerve injury. © 1995 Jons Wiley & Sons, Inc.
Parapharyngeal space neoplasms
Authors: Hughes Kenneth V. , Olsen Kerry D. , McCaffrey Thomas V.
Published: February 2007

Background. Primary parapharyngeal space neoplasms are rare. Tumor distribution characteristics and long‐term outcome have been quite variable in the recent literature. We report the results of a retrospective review of 172 patients with primary parapharyngeal space neoplasms treated surgically from 1960 to 1990 at a large multispecialty clinic and teaching hospital.

Methods. Initially, 195 patients seen at our institution were found to have parapharyngeal space neoplasms. Twenty‐three patients previously treated elsewhere were excluded. The remaining 172 patients (96 female and 76 male) were from 11.7 months to 91.5 years of age. All patients were treated surgically; the transparotid‐cervical approach was most widely used.

Results. One hundred thirty‐seven tumors (80%) were benign and 35 (20%) were malignant. High‐resolution computed tomography or magnetic resonance imaging was essential in the diagnosis and presurgical planning. Fineneedle aspiration specimens were accurate in the diagnosis of 8 of 9 cases. Pleomorphic adenoma was the most common neoplasm (40%), followed by paraganglioma (20%), neurogenic tumor (14%), malignant salivary gland tumor (13%), miscellaneous malignant tumors (7%), and miscellaneous benign tumors (6%). Mandibulotomy was required for only 6% of all tumors; its use was reserved for malignant lesions and large skull base tumors when risk of tumor rupture was high. Recurrent or persistent disease was recorded in 27 patients with malignant tumors; of these, 24 (89%) are likely to die of disease.

Conclusions. The transparotid‐cervical approach is the preferred procedure for most parapharyngeal tumors and can be combined with midline mandibulotomy for large vascular or selected malignant tumors. Recurrence after removal of pleomorphic adenomas is only 4%. Recurrent or persistent malignant disease is nearly always fatal. Perioperative mortality is zero, and morbidity is most often associated with cranial nerve neuropathy. © 1995 Jons Wiley & Sons, Inc.
Incidence of cervical metastasis from uveal melanoma: Implications for treatment
Authors: Tojo David , Wenig Barry L. , Resnick Kenneth I.
Published: February 2007

Background. Although the literature has focused on the propensity of uveal melanoma to metastasize to the liver, little attention has been directed to its spread in regional, cervical lymph nodes.

Methods. We reviewed records of 77 patients who underwent primary resection of uveal melanoma during a 15‐year period at our institution.

Results. A total of only 6.5% of patients developed cervical metastasis. Factors such as age, race, sex, tumor location, and histology were not influential in identifying these patients. Tumor size and local orbital recurrence were, however, associated with a higher risk of cervical lymphadenopathy (p < 0.05). Cervical metastases were also associated with the presence of distant metastatic disease.

Conclusion. Neck dissection should be reserved for patients with clinically demonstrable lymphadenopathy only after distant disease has been excluded. © 1995 Jons Wiley & Sons, Inc.
Breast carcinoma metastatic to paranasal sinuses
Authors: Austin John R. , Kershiznek Matthew M. , McGill Diana , Austin Sara G.
Published: February 2007

Background. Breast cancer affects 150,000 women a year in the United States. Breast carcinoma that is metastatic to the paranasal sinus (PNS) is rare. A patient with breast cancer treated recently at the University of Texas M. D. Anderson Cancer Center developed bilateral metastasis to the ethmoid sinuses. This case prompted a review of the incidence of this disease, its treatment, and outcome.

Methods. A review of the published reports dating back to 1939 of breast carcinoma that was metastatic to the PNS was performed. In addition, autopsy series in the breast oncology literature were reviewed for cases of breast carcinoma that was metastatic to the PNS.

Results. From this review, we identified only eight cases of breast carcinoma that was metastatic to the PNS. All cases were unilateral and presented as mass lesions. Despite treatment, all patients died soon after diagnosis.

Conclusions. We conclude that breast carcinoma metastatic to the PNS is rare and has been uniformly fatal because, as disseminated disease, it does not respond well to conventional systemic therapies. © 1995 Jons Wiley & Sons, Inc.
Benign parotid adenomas: A review of the princess margaret hospital experience
Authors: Liu Fei‐Fei , Rotstein Lorne , Davison Alan J. , Pintilie Melania , O'Sullivan Brian , Payne David G. , Warde Padraig , Cummings Bernard
Published: February 2007

Background. The morbidity of treating benign parotid tumors is an important issue because the majority of patients are young. We therefore undertook this study to evaluate the outcome for these patients treated at the Princess Margaret Hospital.

Methods. A retrospective review was conducted on all patients registered with benign parotid tumors between 1970 and 1987.

Results. Seventy‐six patients were included in this review; postoperative radiotherapy (XRT) was administered to 55 patients. Median follow‐up time was 12.5 years. Postoperative XRT was particularly important for patients with recurrent disease. The risk of both temporary and permanent facial nerve paralyses increased with each operation. No patients in this study developed a malignancy.

Conclusions. We recommend that all patients with benign parotid tumors be treated with a complete parotidectomy with preservation of the facial nerve. Consideration to postoperative XRT should be given to patients in whom there was tumor spillage, residual disease, or recurrences. © 1995 Jons Wiley & Sons, Inc.
Extent of lymph node dissection in T3/T4 cancer of the alveolo‐buccal complex
Authors: Rao Raja S. , Deshmane Vinay H. , Parikh Hemen K. , Parikh Deepak M. , Sukthankar Pinni S.
Published: February 2007

Background. Cancer of the alveolo‐buccal complex even when locally advanced is amenable to curative resection. However, the extent of lymph node dissection remains controversial.

Methods. A total of 181 patients with T3/T4 cancer of the alveolo‐buccal complex who underwent a radical neck dissection (RND) were analyzed retrospectively to determine the incidence and pattern of lymph node involvement and to define the extent of neck dissection required in these cancers.

Results. Lymph node involvement was as follows: level I (85%), II (51%), III (19%), IV (18%), V (5%). Levels I and II were most commonly involved (94%). Skip metastases occurred in 13%. Levels IV and V were involved in 2% and 20% when levels I, II, and III were uninvolved and involved, respectively.

Conclusion. A supraomohyoid neck dissection (SOHD) should be performed and subjected to a frozen section evaluation in every patient. If lymph nodes are negative, then SOHD is adequate. If levels I, II, or III are positive, then a RND should be performed. © 1995 Jons Wiley & Sons, Inc.
Adenoid cystic carcinoma: Significance of DNA ploidy
Authors: Tytor Maciej , Gemryd Per , Grenko Ronald , Lundgren Jan , Lundquist Per‐G. , Nordenskjöld Bo
Published: February 2007

Background. DNA ploidy pattern is sometimes used as a prognostic factor. Heterogeneity of a tumor could, however, give false information when a single analysis is performed.

Methods. Twenty‐eight patients with adenoid cystic carcinomas were retrospectively studied with regard to clinicohistologic parameters, and in 24 of these the DNA pattern was assessed using flow cytometry, with multiple analysis from different tumor parts, to determine prognostic factors.

Results. Of the carcinomas, 33% (8/24) were DNA aneuploid, and 17% (4/24) of the tumors showed intratumoral heterogeneity of DNA content; two of them with mixture of diploid and aneuploid stemlines. The DNA aneuploid tumors were clinically more advanced and demonstrated a higher frequency of solid architecture than did diploid tumors (p < 0.05). The S‐phase values were significantly higher in aneuploid samples than in diploid ones (p < 0.05). The recurrence rate was significantly higher in patients with aneuploid tumors (75%) than with diploid ones (19%) (p < 0.05). The cumulative survival was worse for patients with aneuploid tumors than for those with diploid ones (p < 0.05).

Conclusions. Our findings suggest a potentially important role for flow cytometry in evaluation of adenoid cystic carcinoma. It is of interest to observe that in some tumors both diploid and aneuploid stemlines can co‐exist. If one sample is analyzed and demonstrates diploid cells, there is a 3% chance that the tumor is also heterogenous with aneuploid stemlines. If one sample demonstrates aneuploid cells, there is a 7% chance for heterogeneity with diploid cells, as well. Two samples from different tumor parts can be considered representative. © 1995 Jons Wiley & Sons, Inc.
Management of tracheal wall resection for thyroid carcinoma by tracheocutaneous fenestration and delayed closure using auricular cartilage
Authors: Sugenoya Akira , Matsuo Kiyoshi , Asanuma Kazuhiko , Shingu Kiyoshi , Shimizu Tadahiro , Masuda Hiroyuki , Kobayashi Shinya , Iida Futoshi
Published: February 2007

Background. In the case of advanced thyroid carcinoma invading the trachea, surgical procedures for tracheal resection are selected in relation to the degree of invasion. We created a tracheocutaneous fenestration that was later closed with a free auricular cartilage autograft. We present a simple and effective method for permanent closure of tracheostoma.

Methods. The surgical procedure for delayed closure consists of three steps: (1) preparing the hinge flap with additional undermining of the subcutaneous layer and the strap muscles; (2) removing a portion of the conchal cartilage from the auricle, which is easily performed with a semicircular skin incision along the anthelix of the ear; and (3) placing the conchal cartilage with its convex surface upward just over the sutured hinge flap layer.

Results. Under local anesthesia, we successfully employed this reconstructive procedure for 5 patients. Unfortunately, however, in one patient, we had to reopen the closed tracheocutaneous fenestration on the second postoperative day because of an acute problem that was independent of the closure surgery. Four patients remain in satisfactory condition for more than 2 years since the closure of tracheostoma.

Conclusions. The auricular cartilage free graft is a relatively simple procedure which supplies tracheal wall skeletal support for the permanent closure of the tracheocutaneous fenestration. © 1995 Jons Wiley & Sons, Inc.
Epilarynx: Pharynx or larynx?
Authors: Lefebvre Jean‐Louis , Buisset Etienne , Coche‐Dequeant Bernard , Ton Van Jean , Prevost Bernard , Hecquet Bernard , Demaille Alain
Published: February 2007

Background. As a general rule, epilarynx is studied as a part of supraglottis. On the contrary, in France, due to its particular natural history, it is often studied separately.

Methods. To assess the value of this French classification, we compared from an epidemiologic point of view, in one study, 86 cases of epilarynx squamous cell carcinoma (SCC) with 431 oropharynx, 339 hypopharynx, and 89 vestibule SCC. In another study, we compared, from a clinical point of view, 232 epilarynx SCC with 1351 oropharynx, 652 hypopharynx, and 372 vestibule SCC.

Results. Epilarynx patients appeared to be much heavier drinkers than larynx patients and similar to pharynx patients but tobacco consumption did not differ. The patterns of nodal involvement were similar for pharynx and epilarynx SCC. For stages I and II, patterns of failures were similar, but for stages III and IV, there were fewer locoregional failures in vestibule patients; distant metastases were equally frequent for these tumors. From the standpoint of multiple primaries, epilarynx SCC appeared to be more akin to pharynx than to larynx SCC with a much lower incidence of lung cancers. Finally, the outcome after treatment was different for vestibule, epilarynx, and pharynx SCC, with a 5‐year survival of 43%, 27%, and 13%, respectively.

Conclusions. These data support the identification of epilarynx as a real entity that should be taken into account for stratification in clinical trials. © 1995 Jons Wiley & Sons, Inc.
Thorascopic staging of stomal recurrence
Authors: Wax Mark K. , Garnett James David , Graeber Geoffrey
Published: February 2007

Background. Squamous cell carcinoma of the low cervical area may be secondary to stomal recurrence following laryngectomy, low cervical esophageal disease, or peritracheal metastasis. Most often patients with disease in this area have already received both surgery and radiotherapy. Prior to Sisson's description of the trans‐sternal radical neck dissection or mediastinal dissection the management and prognosis was uniformly poor. Since then, a number of authors have reported their experience with mediastinal dissection. Survival remains poor but palliation has been acceptable. Unfortunately, resectability of the disease cannot often be determined prior to the actual surgical procedure. A number of patients are explored only to have the procedure terminated.

Thoracoscopy is a procedure that involves insertion of two or three trocars into the right thoracic cavity with collapse of the right lung. A form of endoscopic surgery, it permits visualization and dissection of the important structures of the mediastinum. Tracheal, esophageal, and great vessel invasion by tumor can be evaluated.

Methods. Prospectively, all patients initially seen with stomal recurrence from 1991 to 1994 were evaluated. CT scans, MRIs as well as thoracoscopy were performed when indicated.

Results. One patient required conversion to a minithoracotomy involving a 7‐cm chest incision. The patient was found to have unresectable disease with tumor involving the great vessels of the mediastinum. A second patient was found to have unresectable disease with tumor encasing the subclavian artery. The third patient was found to have no mediastinum involvement.

The patient with no mediastinum involvement underwent a stomal resection with mediastinal dissection. Reconstruction with a pectoralis major myogenous flap was performed. The patient has remained disease free to date. The remaining two patients were judged to have unresectable disease and were offered palliative treatment. Both of these patients died of the disease within 6 months.

Conclusions. Thoracoscopy provides important information in judging the surgical resectability of patients with stomal recurrence. This procedure has not been previously described in the otolaryngologic literature. We provide some suggestions for its use in the evaluation of the mediastinal extent of disease. © 1995 Jons Wiley & Sons, Inc.
Micrometastases in carcinoma of the upper aerodigestive tract: Detection, risk of metastasizing, and prognostic value of depth of invasion
Authors: Ambrosch Petra , Kron Martina , Fischer Gösta , Brinck Ulrich
Published: February 2007

Background. The purpose of this study was to investigate the incidence of micrometastases from squamous cell carcinomas of the upper aerodigestive tract in neck dissection specimens, and to determine whether features of the primary tumor might be of prognostic value for metastasizing.

Methods. Seventy‐six originally pN0 staged neck dissection specimens from 60 patients were evaluated using serial sectioning in 10‐μm intervals, H&E‐staining and immunostaining with an antibody to pan‐cytokeratin. The influence of the variables pT‐category, cytologic grade, and maximum depth of invasion of the primary tumor on the nodal status was analyzed in 128 patients.

Results. The examination of 1020 lymph nodes from 76 neck dissection specimens revealed 8 micrometastases in 6 specimens (7.9%) from 6 patients with oral and pharyngeal primaries, resulting in upstaging. Six micrometastases were located in lymph nodes of 3–6 mm in diameter. Depth of invasion was the only significant risk factor for metastasizing selected in logistic regression.

Conclusion. The surgeon should be aware of a relatively high incidence of micrometastases from oral and pharyngeal carcinomas, which are neither detectable preoperatively nor histopathologically by a reasonable effort. The measurement of the maximum depth of invasion of the primary can delineate a group of patients who should be treated by elective neck dissection. © 1995 Jons Wiley & Sons, Inc.
Prognostic factors in minor salivary gland cancer
Authors: Anderson J. Noble , Beenken Samuel W. , Crowe Ralph , Soong Seng‐Jaw , Peters Glenn , Maddox William A. , Urist Marshall M.
Published: February 2007

Background. Minor salivary gland cancer occurs infrequently and presents a diagnostic and therapeutic challenge. The purpose of this study was to determine prognostic factors for this disease.

Methods. The medical records of 95 patients diagnosed and treated at the University of Alabama at Birmingham over a 35‐year period were reviewed. Information concerning patient, disease, and treatment characteristics was compiled for each case. Multivariate analysis was conducted using a rank regression procedure.

Results. Stage I or II cancer (p = .022), the absence of cervical lymph node metastases (p = .001), and surgical margins which were free of cancer (p < .001) were predictive of increased 4‐year disease‐free survival by multivariate analysis.

Conclusion. Our findings emphasize the need for detection of early‐stage disease combined with complete surgical extirpation of the cancer, which provide the patient with the best chance for locoregional control and long‐term survival. © 1995 Jons Wiley & Sons, Inc.
Prognosis of recurrent laryngeal carcinoma after laryngectomy
Authors: Yuen Anthony Po Wing , Ho Chiu Ming , Wei William Ignace , Lam Lai Kun
Published: February 2007

Background. Recurrence is common after total laryngectomy for advanced laryngeal carcinoma. The aim of the present study was to review the prognosis of recurrent laryngeal carcinoma after total laryngectomy.

Methods. The records of 165 patients who developed recurrences after total laryngectomy for laryngeal squamous cell carcinoma between January 1971 and December 1990 were reviewed.

Results. Of the 165 patients who developed recurrences, 34 (21%) patients had surgical salvage. The sites of recurrence of these 34 operable patients included 11 pharyngeal, 3 tracheostomal, 15 nodal, 2 pharyngeal with nodal, and 3 pulmonary metastasis. Pharyngeal recurrence had the highest salvage rate, followed by nodal and pulmonary recurrence. All patients with tracheostomal had recurrence after salvage surgery. After the surgical salvage, the tumor recurrence rate was 44% and the 5‐year actuarial survival rate was 42%. Of the other 131 patients who had palliative treatment without surgical salvage, the 5‐year actuarial survival rate was 2%.

Conclusions. The present study showed that patients who had surgical salvage for recurrent tumor after total laryngectomy had satisfactory prognosis. Close follow‐up of patients after initial operation is essential to detect recurrence early, while surgical salvage is still feasible.
Liver function studies in the assessment of head and neck cancer patients
Authors: Korver Kurtis D. , Graham Scott M. , Hoffman Henry T. , McCulloch Timothy , Funk Gerry F.
Published: February 2007

Background. Serum liver function tests (LFTs) are used in the initial evaluation of patients with head and neck squamous cell carcinoma (SCC) to evaluate hepatic function and to screen for liver metastases.

Methods. One hundred forty patients initially seen with SCC between 1988 and 1991 were followed for a minimum of 2 years to determine the significance of abnormal LFTs at presentation.

Results. Abnormal values were found in 69 patients (49%), including elevated alkaline phosphatase in 37 (26%) and lactic dehydrogenase in 25 (18%). Abnormal values were most commonly attributed to alcohol‐related liver disease. No liver metastases were identified at initial screening. LFTs were normal at presentation in all three patients subsequently identified with liver metastases during follow‐up.

Conclusions. Abnormal LFTs are commonly encountered but are of little value in identifying patients with liver metastases during initial assessment. Modest elevation of LFTs should not necessitate costly and time‐consuming investigation to exclude hepatic metastasis. © 1995 Jons Wiley & Sons, Inc.
Silencing of hyaluronan synthase 2 suppresses the malignant phenotype of invasive breast cancer cells
Authors: Li Yuejuan , Li Lingli , Brown Tracey J. , Heldin Paraskevi
Published: February 2007

Accumulation of hyaluronan has been demonstrated in the peritumoral breast cancer stroma and nests of tumor cells. In this study, we have quantified the production of hyaluronan and the expression of mRNAs encoding hyaluronan synthesizing (HAS) and hyaluronan degrading (HYAL) enzymes in a panel of breast cancer cell lines. The analysis revealed that highly invasive breast cancer cells produce high amounts of hyaluronan and express preferentially HAS2 mRNA, whereas less invasive breast cancer cells produce low amount of hyaluronan and express HAS1 and HYAL1 mRNAs. We explored the importance of HAS2 expression for breast cancer tumorigenicity, by specifically silencing the HAS2 gene using RNA interference (RNAi)‐mediated suppression in the invasive breast cancer cell line Hs578T. This led to a less aggressive phenotype of the breast tumor cells, as assessed by cell growth, both in anchorage‐dependent and anchorage‐independent cultures. siRNA‐mediated knock down of HAS2 in Hs578T breast tumor cells led to an up‐regulation of HAS1, HAS3 and HYAL1 mRNAs, resulting in only a 50% decrease in the net hyaluronan production; however, the synthesized hyaluronan was of lower size and more polydisparse compared to control siRNA‐treated cells. Interestingly, Hs578T cells deprived of HAS2 migrated only half as efficiently as HAS2 expressing cells through cell‐free areas in a culture wounding assay and through Transwell polycarbonate membrane as well as invaded a Matrigel layer. These results imply that alterations in HAS2 expression and endogenously synthesized hyaluronan affect the malignant phenotype of Hs578T breast cancer cells. © 2007 Wiley‐Liss, Inc.
Treatment of thrombotic thrombocytopenic purpura with plasma exchange, antiplatelet agents, corticosteroid, and plasma infusion: Mayo clinic experience
Authors: Breckenridge Robert L. , Solberg Lawrence A. , Pineda Alvaro A. , Petitt Robert M. , Dharkar Dilipkumar D.
Published: February 2007

Ten patients with thrombocytopenia (TTP) were treated recently in our institution with plasma exchange (PE), steroids, and antiplatelet drugs. Additionally, fresh frozen plasma (FFP) was administered to nine patients, with folic acid given to eight patients.

After 13 to 25 months of follow‐up, we found that four patients achieved and remained in remission after initial treatment. Three patients had four relapses, which developed while they were taking antiplatelet therapy, and which were treated successfully with FFP alone, or with PE in addition to FFP. Four patients suffered major neurological or renal damage during their presentation or initial treatment. One of these patients died during his initial hospitalization. Another patient died 7 months after initial treatment.

After analyzing this experience, we have concluded that antiplatelet drugs or corticosteroid should be used as the sole initial treatment most cautiously. The relative importance of the exchange process, per se, versus plasma infusion cannot be inferred from our observations, but plasma exchange with FFP appears to have had a real impact on recovery.
Plasmapheresis in lupus nephritis with nephrotic syndrome: A long‐term followup
Authors: Wallace Daniel J. , Goldfinger Dennis , Bluestone Rodney , Klinenberg James R.
Published: February 2007

Lupus nephritis with nephrotic syndrome is one of the most serious complications of systemic lupus erythematosus. Six female patients with systemic lupus and nephrotic syndrome, refractory to immunosuppressive drug therapy, received 15–20 exchange plasmaphereses. One patient, treated concurrently with high‐dose steroids, showed temporary improvement, and five patients, treated concurrently with steroids and either cyclophosphamide or azathioprine, had long‐term remissions. Plasmapheresis is a promising therapeutic modality in cases of refractory lupus nephritis with nephrotic syndrome.
A technique for easy vascular access in patients undergoing plasmapheresis
Authors: Khatri Bhupendra Odhavji
Published: February 2007

Gaining vascular access in some patients undergoing plasmapheresis procedure may prove to be difficult. Twenty‐four percent of our patients had either a poor vascular access or poor blood flow. This report describes a technique for obtaining good vascular access in otherwise difficult patients, which we believe to be easy, safe, time saving and cost effective.
Partial plasma protein replacement in therapeutic plasma exchange
Authors: McLeod Bruce C. , Sassetti Richard J. , Stefoski Dusan , Davis Floyd A.
Published: February 2007

We wished to determine whether subtotal replacement of protein in plasma removed at plasma exchange would be adequate to prevent hypovolemia and hypoproteinemia. Seven well nourished outpatients with chronic progressive multiple sclerosis underwent 60 plasma exchanges in which two liters of plasma were replaced with 750 ml saline followed by 1250 ml of a 5% albumin solution (62.5% albumin replacement). Total serum protein, protein electrophoresis, and immunoglobulin levels were measured before and after each exchange. Clinically, the exchanges were well tolerated. Total serum protein dropped by a mean of only 18% during the study and mean preexchange serum albumin levels were unchanged, even though immunoglobulins decreased by 57–72%. We conclude that in well nourished patients, partial albumin replacement of this magnitude is an adequate substitute for plasma removed in a plasma exchange.
Mononuclear cell (MNC) collection by continuous‐flow centrifugation (CFC)
Authors: Hester Jeane P. , Kellogg Robert M. , Freireich Emil J.
Published: February 2007

Mononuclear cell separation and collection by continuous‐flow centrifugation relates to centrifugal acceleration, total blood processed, peripheral blood concentration, and probable mobilization from extravascular sites during the procedure. At low‐G forces, 70–80% of mononuclear cells are cleared. As G forces are increased, 95–100% of mononuclear cells can be cleared, but excessive platelet depletion occurs. An average of three billion cells were harvested from 2–3 liters of blood, rising to nine billion when 6 liters were processed. The total blood processed is defined by citrate infusion rates and ionized calcium changes. Large quantities of mononuclear cells were collected from normal donors without any significant depletion. If the objective of harvesting mononuclear cells is depletion, intensive schedules may be needed.
Therapeutic cytapheresis in chronic lymphocytic leukemia
Authors: Marti G. E. , Folks T. , Longo D. L. , Klein H.
Published: February 2007

The role of therapeutic reductive lymphapheresis in 59 patients with chronic lymphocytic leukemia (CLL) was reviewed. Reduction in lymphocytosis, lymphadenopathy and hepatosplenomegaly was noted in 50%–60% of the patients studied. In addition to mobilization of the lymphoid tumor load, 40% of the patients showed an improvement in their hemogram. Although apheresis‐induced anemia can occur, reported complications were minimal. These studies suggest that a majority of CLL patients might benefit from therapeutic lymphapheresis.
Granulocyte collection: A comparison of fenwal CS 3000, IBM 2997, and haemonetics cell separators
Authors: Eckermann Imelda , Strauss R. G.
Published: February 2007

With the advent of sophisticated automated blood processors, the collection of large numbers of granulocytes for transfusion has been made more practical in the past ten years. Harvesting granulocytes by filtration leukapheresis has been abandoned in most centers because of adverse reactions in both donors and recipients. Currently, both continuous and discontinuous flow centrifugation leukapheresis techniques are available. However, both corticosteroids and hydroxyethyl starch are required for optimal granulocyte collection. In this paper, we critically compare the three major cell separators used for the collection of granulocytes by centrifugation leukapheresis.

All three instruments separate blood cells by centrifugation; the IBM‐2997 and the Fenwal CS‐3000 function by continuous‐flow centrifugation, and the Haemonetics Model 30 by discontinuous‐flow centrifugation. Factors such as the donor preapheresis white blood cell count, the blood flow rate through the machine and the centrifuge speed effect granulocyte collection. Comparisons will be made of the cost of the software for each machine, the time required for granulocyte collection, the convenience of set‐up and tear‐down, the amount of skill and experience demanded of the operator. Donor factors will be discussed. Since the blood processor may be used for other procedures including plateletpheresis, therapeutic plasma exchange, lymphocytapheresis and erthrocytapheresis, the pros and cons of each machine as used for some of these procedures will be included in the discussion.

In our experience, total leukocytes and granulocytes (neutrophils) collected with the three different instruments varied only slightly when unstimulated donors were studied. Total WBC × 109 per granulocyte pack were 16.7 ± 0.85 for CS‐3000 (N=37), 16.3 ±0.95 for IBM‐2997 (N=47) and 13.3 ±0.09 for Model 30 (N=179). Neutrophils × 109 per pack were 8.4 ± 0.42, 8.2 ± 0.47 and 7.4 ± 0.28, respectively. Granulocyte yields can be increased 2–3 fold when donors are stimulated with corticosteroids, particularly with the continuous‐flow machines. Platelet collection varied greatly. The largest number of platelets per granulocyte pack was collected with the Haemonetics Model 30 (7.5 × 10″ ±0.13). The Fenwal CS‐3000 had the next highest platelet yield with 3.6 × 10″ ±0.12, the IBM‐2997 collected 2.6 × 10″±0.16. Erthrocyte contamination was greatest with the Model‐30.
Putative methods for prevention and treatment of neonatal septicemia
Authors: Christensen Robert D.
Published: February 2007

The high mortality rate observed in newborn infants who contract bacterial sepsis within the first days of life has prompted investigators to seek new methods for the prevention and treatment of this disorder. Among the putative measures recommended for prevention are: (1) administration of antimicrobials to all infants at the time of delivery, (2) identification and treatment of pregnant women colonized with those bacteria known to be major neonatal pathogens and (3) immunization of women to major neonatal pathogens. Three other measures, targeted at diminishing the mortality and morbidity in those in whom preventive measures fail, include: (1) granulocyte transfusion, (2) exchange transfusion and (3) administration of antibody.