Biomedical subjects

A J Balm

Publications and source records attributed to A J Balm.

At least 37 records · Page 2Linked to original sources

PubMed1998

Imaging of squamous cell carcinoma of the hypopharynx.

The hypopharynx is a clinically silent area and early lesions may be asymptomatic for a long period. At presentation, primary squamous cell carcinoma of this area is usually advanced. Almost all of these lesions are studied with imaging as part of the clinical work-up. The goal of this article is to help the practicing radiologist convey a report which provides information that will directly influence treatment of patients with hypopharyngeal carcinoma.

Carcinoma, Squamous Cell↗

PubMed1998

Multiple malignancies in a patient with bilateral retinoblastoma.

A case is presented of a patient with bilateral retinoblastoma, treated at infancy with surgery, chemotherapy and radiotherapy, who subsequently developed at least four additional histologically distinct malignancies: a Ewing sarcoma of the left fibula, two extraskeletal osteosarcomas of the left lower extremity, a mucoepidermoid carcinoma of the right parotid gland and a squamous cell carcinoma of the left paranasal cavity. In addition to retinoblastoma, patients with a germline RB-1 mutation are at high risk of second primary malignancies. An additive carcinogenic effect of cytotoxic therapy in these patients has been assumed. Patients with hereditary retinoblastoma should be under life-long follow-up programmes including a regular head and neck examination for detection of new primaries, especially in the radiation field of the presenting retinoblastoma.

Adult↗

PubMed1998

Structured assessment of the consequences of composite resection.

A structured quality of life questionnaire was developed as an instrument for the assessment of the functional, physical, psychosocial, and counselling problems in patients treated surgically for an oropharyngeal cancer. The questionnaire was tested in a pilot study in a relatively homogeneous group of 15 selected patients (all of whom had a comparable surgical defect, i.e. a composite resection of the oropharynx and neck, and had undergone an identical reconstruction method, i.e. a pedicled pectoralis major myocutaneous flap). All but two patients were irradiated as well. A high reliability (Crombach's alpha) was found in most of the applied subscales, indicating good internal consistency of the different questions. Significant correlations were found between several quality of life dimensions. The most frequently reported complaints concerned problems related to eating, speaking, and facial disfigurement. Problems with mastication, oral transport, and swallowing prohibited 11 patients returning to their normal diet. Regarding speech, 11 patients reported decreased intelligibility, in eight this was due to some degree of rhinolalia aperta. A significant association was found between moderate intelligibility and anxiety about speaking in public (P < 0.05). Eleven patients felt that the surgery had caused considerable facial disfigurement. For five of them this had a negative influence on their social interactions and activities outdoors. Thus, the consequences of the surgical treatment of oropharyngeal cancer can be assessed in a systematic and formal way with this specially designed structured questionnaire. Despite the small sample size, the selection of a homogeneous patient group appeared to give significant information, and to establish meaningful correlations.

Aged↗

PubMed1998

Long-term compliance of laryngectomized patients with a specialized pulmonary rehabilitation device: Provox Stomafilter.

Previous studies have demonstrated the positive effect of a heat and moisture exchanger (HME) on the respiratory system in patients after laryngectomy. However, patient compliance with these devices was reduced by device-related problems and troublesome combination with a voice prosthesis. Recently a more specialized device has become available. This is an HME combined with a valve for easy digital occlusion of the stoma (Provox Stomafilter; Hörby, Sweden). In the authors' initial study of this revised device, a clear improvement in short-term compliance was demonstrated. To investigate long-term compliance, 69 consecutive patients were interviewed by means of a structured questionnaire. The results show that all patients expressed their satisfaction with the valve used for digital occlusion of the stoma. Sixty-three percent of the patients reported that voicing was facilitated. Subjective intelligibility improved in 55% of the patients. Previous problems with other devices (e.g., plaster adherence, skin irritation, and handling) were clearly diminished, increasing the long-term compliance of the patients to 78%. This new HME can be considered as a beneficial pulmonary rehabilitation tool for laryngectomized patients.

Adult↗

PubMed1997

[Nasopharyngeal carcinoma: epidemiology and treatment outcome].

OBJECTIVE: To determine epidemiology, symptoms and treatment results of patients with nasopharyngeal carcinoma. DESIGN: Descriptive and retrospective. SETTING: The Dutch Cancer Institute (Antoni van Leeuwenhoek Hospital), Amsterdam, the Netherlands. METHODS: The clinical, epidemiological and radiotherapy data of the 129 patients with a nasopharyngeal carcinoma referred between 1977 and 1993 to our hospital were analysed. Twenty patients were referred for a second opinion only, presented with recurrent disease, or had received their treatment elsewhere. Data of 109 patients were analysed. RESULTS: During the last decade more patients born in Asia and North-Africa were referred (p = 0.0057), a total of 52 (48%) out of 109 referred patients. There were 62 (58%) patients in whom an enlarged cervical lymph node at level II (upper jugular group) was the presenting symptom. In 53 (50%) cases hearing loss due to otitis media with effusion was the first symptom. In 54 (54%) patients the delay between the first symptoms and diagnosis of carcinoma was > 20 weeks. 5-year survival was 48% (SE 6%) for the whole group (n = 109) of patients and 52% (SE 6%) for the patients treated with curative intent (n = 96). CONCLUSION: During the last decade the population of patients with nasopharyngeal carcinoma in the Netherlands contained more patients from Asia and North-Africa. Suspicious cervical lymph node swellings and (or) (unilateral) otitis media with effusion may be indicative of a nasopharyngeal carcinoma.

Adolescent↗

PubMed1997

[An innocuous prolonged unilateral nose blockage?].

A woman aged 35 and a man aged 59 had been suffering for years from unilateral clogged nose. Adequate diagnostic examination revealed in both of them a papilloma inversum from which a squamous carcinoma had developed. After extensive surgical resection of the tumour and irradiation, tumour progression and metastasization occurred. Both patients were given palliative chemotherapy; they died soon after the last course. Problems concerning nasal breathing are common in general practice. They are often attributed to common cold or to an allergy. Unilateral blocking of the nose is usually caused by a congenital or a traumatic deviation of the nasal septum. However, in adult patients, it may rarely be due to a tumour.

Adult↗

PubMed1997

Overexpression of cyclin D1 indicates a poor prognosis in squamous cell carcinoma of the head and neck.

OBJECTIVES: To evaluate the overexpression of cyclin D1 and p53 as a prognostic marker of squamous cell carcinoma of the head and neck and to investigate whether deregulation of these genes is associated with an unfavorable course of disease. DESIGN: Retrospective study. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tumor materials that were obtained from a well-characterized series of 115 patients with resectable head and neck cancer at The Netherlands Cancer Institute, Amsterdam, were analyzed by immunohistochemical methods using antiserum samples that were directed against 2 proteins (ie, cyclin D1 and p53), which are crucial in the regulation of the G1 phase of the cell cycle. RESULTS: Overexpression of cyclin D1 protein was found in 49% of the patients with squamous cell carcinoma of the head and neck. This overexpression was not associated with known prognostic factors (eg, the T and N stages). Tumors recurred more frequently and in a shorter period in patients whose primary tumors showed an overexpression of cyclin D1 protein. This difference (P = .05) was statistically significant in a stepwise proportional hazard regression analysis. However, since a discrepancy in staining results was observed between the biopsy and resection materials that were taken from the same patient, this result may not have been applicable in the evaluation of biopsy specimens only. This discrepancy is most likely owing to tissue heterogeneity. The overexpression of p53 that was found in 42% of the patients was of no prognostic significance. CONCLUSIONS: These data provide evidence that overexpression of cyclin D1 protein in resection material of squamous cell carcinomas of the head and neck is indicative of a poor prognosis, independently of other known prognostic factors. Whether overexpression of cyclin D1 may therefore be used to select patients for more intensive treatment should be examined in the context of a clinical trial.

Adult↗

PubMed1997

Variability of tumor volumes in T3-staged head and neck tumors.

BACKGROUND: The Tumor Node Metastasis (TNM) classification system describes head and neck tumors using anatomic or unidimensional criteria and may therefore fail to define the actual three-dimensional tumor bulk. To investigate this we measured variability of tumor volumes (Vvol) in T3-staged head and neck tumors. METHODS: Patient material consisted of pretreatment computerized tomography (CT) scans of 71 patients, seen between 1990 and 1995, with T3 head and neck carcinoma involving different subsites. Computerized tomographic scans of 42 patients displayed distinct tumor boundaries and were free of motion and/or dental artifacts. Using these scans, tumor volumes were measured using the summation-of-areas technique, and Vvol was determined. RESULTS: Following are the tumor-volume measurements: T3 larynx carcinoma (n = 12) Vvol, 1.7-17.0 mL (median 3.7 mL); T3 oropharynx carcinoma (n = 13) Vvol, 10.0-41.2 mL (median 18.3 mL); T3 hypopharynx carcinoma (n = 10) Vvol, 8.9-67.8 mL (median 17.4 mL); T3 nasopharynx carcinoma (n = 3) Vvol, 3.7-30.1 mL; T3 maxillary sinus carcinoma (n = 4) Vvol, 56.0-103.1 mL. CONCLUSIONS: T3-Staged tumors of the head and neck show considerable variability of tumor volumes. Incorporation of tumor volume data may further refine the TNM staging system.

Adult↗

PubMed1997

Localizing the sentinel node in cutaneous melanoma: gamma probe detection versus blue dye.

BACKGROUND: Sentinel node (SN) biopsy can be used to select patients with melanoma for therapeutic lymphadenectomy. We investigated the value of two methods to locate the SN: patent blue dye (PBD) and gamma probe detection of 99mTc-nanocolloid. METHODS: One hundred ten patients with cutaneous melanoma were studied. Lymphoscintigraphy with 99mTc-nanocolloid was performed to determine the position of the SN. Before operation, PBD was injected at the same site as the radiopharmaceutical. When a blue node was identified intraoperatively, its radioactivity level was measured with the probe. In the absence of blue coloration, the probe was used to trace the SN. RESULTS: Scintigrams visualized a total of 219 SNs in 141 basins. Eight SNs were not explored. One SN was not found. The remaining 210 and 27 additional intraoperatively identified SNs were excised. From the total of 237 removed SNs, 200 (84%) were found using PBD only. All 37 nodes that were not found with the PBD were localized with the probe so that the probe combined with PBD identified 99.5% of all SNs. In 23 patients the SN contained tumor. In three patients the SN was false-negative for metastasis. CONCLUSION: The gamma probe together with PBD can identify more SNs (99.5%) than lymphatic mapping with PBD alone (84%).

Adolescent↗

PubMed1997

Development and clinical evaluation of a second-generation voice prosthesis (Provox 2), designed for anterograde and retrograde insertion.

Prosthetic voice restoration has considerably improved the results of vocal rehabilitation after total laryngectomy, and is presently the method of choice for many health-care providers treating laryngectomized patients. The Provox voice prosthesis, developed in the Netherlands Cancer Institute, is an indwelling device that has been applied in recent years with regular success. Its retrograde replacement method, using a disposable guide wire, assures reliable, atraumatic positioning of the prosthesis in the tracheoesophageal fistula. However, the method sometimes may be uncomfortable for the patient; therefore an adapted prosthesis and new replacement equipment were developed, which enable bidirectional insertion, i.e. not only in the traditional retrograde manner through the pharynx, but especially in an anterograde manner through the stoma. This second-generation voice prosthesis (Provox 2) was studied in a prospective clinical trial in 44 patients (33 experienced patients, seven first-time replacements and four primary insertions). The study demonstrated that the anterograde insertion with the Provox 2 system was applicable in all patients, making the voice prosthesis even easier to handle than with the traditional retrograde method. A stenosis of the pharyngoesophageal segment no longer interfered with the replacement. In addition, the patients judged the new method as being favourable, reporting significantly less discomfort during the replacement procedure (paired Student's t-test: p < 0.0001). Furthermore, the adapted voice prosthesis could be removed from the tracheoesophageal fistula without excessive force (mean 7.9 N, range 6.0-14.0 N), more easily than the original Provox (mean 20.9 N, range 5.5-25.0 N). It can be concluded that this second-generation indwelling voice prosthesis (Provox 2) seems to be a further improvement in the application of this voice rehabilitation system, not only simplifying the replacement procedure, but also diminishing the discomfort for the patient.

Aged↗

PubMed1997

Thallium-201 SPECT in the diagnosis of head and neck cancer.

UNLABELLED: The accuracy of SPECT with 201Tl-chloride for the diagnosis of primary tumors, lymph node metastases and recurrences in head and neck cancer was evaluated for clinical applicability. METHODS: SPECT images, obtained 60 min after administration of 150 MBq 201Tl-chloride, were compared with clinical, CT and/or MRI and histology results. In addition, whole-body images were obtained to detect distant metastases. RESULTS: In 79 patients studied for primary tumors (principally larynix, hypopharynx, oropharynx, nasopharynx and oral cavity), 201Tl SPECT correctly identified 69 of 73 (95% versus 88% for CT/MRI) histologically confirmed malignancies including 63 squamous-cell carcinomas. The method localized four occult naso- and oropharynx carcinomas not seen on CT/MRI and was correctly negative in two patients without tumor and in three of four patients with no confirmed primary tumor in the head and neck. With respect to regional spread, only patients who had cervical lymph node dissection were evaluated, and the findings were recorded per side of the neck. Thallium-201 SPECT correctly identified metastases in 31 of 36 neck dissections with proven lymph node involvement (86%), was correctly negative in nine and false-positive in one. Although the sensitivity of CT/MRI was clearly higher (97%), considerably more false-positive cases affected its accuracy (81% versus 87% for SPECT). In 30 patients investigated for recurrences, 201Tl SPECT correctly identified 27 of 29 microscopically confirmed tumor sites (93%) and was correctly negative in seven. Sensitivity of CT/MRI was lower (76%), and a greater number of false-positives (seven versus three for SPECT) further decreased its accuracy (64% versus 87% for SPECT). Distant metastases were detected in five patients. CONCLUSION: Thallium-201 SPECT appears to be an accurate method for the diagnosis of head and neck cancer. The method is particularly useful for detection of occult head and neck tumors and for assessing recurrences. It also may be of complementary value in the staging of primary tumors, in the differentiation of metastatic from reactive lymph nodes in the neck and, on the basis of whole-body scanning, for screening of distant metastases.

Carcinoma, Large Cell↗

PubMed1996

Preliminary experience with thallous chloride T1 201-labeled single-photon emission computed tomography scanning in head and neck cancer.

OBJECTIVES: To test the feasibility of single-photon emission computed tomography (SPECT) scanning with the use of thallous chloride T1 201 in patients with head and neck cancer and to decide its possible applications to improve the diagnosis and staging of head and neck cancer. DESIGN: Findings from SPECT with the use of 4.32 mCi of thallous chloride T1 201 were compared with those from clinical examination, computed tomography (CT), magnetic resonance imaging, ultrasound-guided fine-needle aspiration, and histologic studies. Primary sites and neck nodes were separately studied. Accuracy, sensitivity, and specifically were calculated for 19 patients who were being assessed for initial treatment (primary sites) and for 12 neck node dissections in 10 patients. SETTING: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam. PATIENTS: A consecutive sample of 25 patients with head and neck cancers of different sites. The average age of the patients was 60.2 years, and there were 19 men and six women. The sites of the primary lesions were as follows: oropharynx (n = 5), larynx (n = 9), oral cavity (n = 4), nasopharynx (n = 1), hypopharynx (n = 3), and unknown (n = 3). RESULTS: For the primary lesions, SPECT identified 94% of the lesions; SPECT was more accurate in delineating four oropharyngeal lesions and one nasopharyngeal lesion. In 12 neck node dissections, SPECT identified all of the positive lesions and two negative lesions, whereas CT detected two false-positive lesions. Single-photon emission computed tomography gave less information about the number of nodes and the anatomy than did CT or magnetic resonance imaging. CONCLUSIONS: Single-photon emission computed tomography with the use of thallous chloride T1 201 appears to be useful in helping to identify occult primary lesions, particularly in the oropharynx. It may assist CT or magnetic resonance imaging in identifying a recurrence of cancer in tissues or in lymph nodes, and in screening for distant metastases. Although no nodes were identified that were not already seen with the use of CT or magnetic resonance imaging, SPECT may help to eliminate the false-positive lesions, and SPECT with the use of thallous chloride T1 201 appears to be a valuable new tool in helping to diagnose and stage head and neck cancer.

Adult↗

PubMed1996

Cytokeratin 18 expression in squamous cell carcinoma of the head and neck.

Cytokeratin (CK) expression was studied in squamous cell carcinomas of different subsites in the head and neck by using cryostat sections from 27 head and neck squamous cell carcinomas (HNSCCs) and 6 cell lines established from HNSCC. All tissues were analyzed immunohistochemically with a panel of monospecific anti-keratin monoclonal antibodies. Most carcinomas recapitulated the expression pattern of keratins present in the basal layer of normal epithelium from the site of tumor origin. Regional differences in the expression of simple-epithelial type of keratins in stratified (pseudostratified) epithelia were to a large extent repeated in corresponding carcinomas. In the present study, localization of various keratins were surveyed and CK 18 specific monoclonal antibodies were specifically used to distinguish SCCs of the larynx or hypopharynx from SCCs of the oral cavity. CK 18 staining of almost all tumor cells was detected in 11 of 12 SCCs of the larynx and hypopharynx, but was only detected sporadically in 3 of 9 SCCs of the oral cavity. The present results show that CK 18 typing might be useful for distinguishing sites of origin of various HNSCCs. Findings also indicate that CK 18 expression in SCC might be modulated by microenvironmental factors.

Antibodies, Monoclonal↗

PubMed1996

Evidence for early and persistent impairment of salivary gland excretion after irradiation of head and neck tumours.

Salivary gland scintigraphy with technetium-99m pertechnetate was used to follow changes in the excretion and uptake function of the major salivary glands until 1 year after irradiation. Twenty-five patients who received radiotherapy for head and neck tumours were included in the study. Seventy-nine salivary glands (39 parotid and 40 submandibular) were evaluated in relation to the average received radiation dose. Salivary gland scintigraphy was performed before and 1, 6 and 12 months after radiotherapy. For each gland the excretion response to carbachol, evaluated by calculation of the salivary excretion fraction (SEF), the cumulative gland uptake (CGU) and the absolute excreted activity (AEA) at various intervals after radiotherapy were compared with the baseline values. The excretion response decreased in 20 of 25 patients at 1 month after radiotherapy. One month after radiotherapy both SEF and AEA decreased significantly in relation to the radiation dose. These decreases in excretion parameters persisted during the follow-up period. Parotid excretion was affected significantly more than submandibular excretion. CGU values did not change significantly until 6 months after radiotherapy, but at 12 months a significant decrease related to radiation dose was observed. Xerostomia was assessed during radiotherapy and on the days of the scintigraphic tests. The incidence of xerostomia did not correspond to the effects observed in the scintigraphic studies. It is concluded that radiotherapy induces early and persistent impairment of salivary gland excretion, related to the radiation dose. This impairment is stronger in parotid glands than in submandibular glands.

Dose-Response Relationship, Radiation↗

PubMed1996

The value of computed tomography scan versus an explorative surgical approach for removal of squamous cell carcinoma of the posterior pharyngeal wall.

BACKGROUND: The prevertebral fascia plays a key role in surgery of posterior pharyngeal wall tumors. Invasion of the prevertebral muscles determines the irresectability of the tumor and accurate diagnosis of invasion posteriorly is a prerequisite for major ablative surgery. METHODS: A retrospective study was performed to define the value of CT scanning versus open neck exploration with regard to the resectability of posterior pharyngeal wall carcinoma. The predictive value of preoperative CT scans was assessed and compared with the outcome of open neck exploration and resectability of the primary tumor, using the final histopathology report as a gold standard. RESULTS: Nineteen patients with 20 tumors were included in this study. Overall the CT scan was correct concerning prevertebral muscle status in 4 out of 20 (20%), whereas open neck exploration was correct in 18 tumors (90%). CONCLUSION: The predictive value of a suspicious CT scan in determining prevertebral muscle invasion is extremely low in this study. Open neck exploration seems to be superior for determining resectability of posterior wall carcinoma.

Adult↗

PubMed1996

Enrichment of tumor cells for cell kinetic analysis in human tumor biopsies using cytokeratin gating.

PURPOSE: To determine the feasibility of using cytokeratin antibodies to distinguish normal and malignant cells in human tumors using flow cytometry. The goal was ultimately to increase the accuracy of cell kinetic measurements on human tumor biopsies. MATERIAL AND METHODS: A panel of four antibodies was screened on a series of 48 tumors from two centres; 22 head and neck tumors (Amsterdam) and 26 esophagus carcinomas (Leuven). First, screening was carried out by immunohistochemistry on frozen sections to test intensity of staining and the fraction of cytokeratin-positive tumor cells. The antibody showing the most positive staining was then used for flow cytometry on the same tumor. RESULTS: The two broadest spectrum antibodies (AE1/AE3, E3/C4) showed overall the best results with immunohistochemical staining, being positive in over 95% of tumors. Good cell suspensions for DNA flow cytometry could be made from frozen material by a mechanical method, whereas enzymatic methods with trypsin or collagenase were judged failures in almost all cases. From fresh material, both collagenase and trypsin produced good suspensions for flow cytometry, although the fraction of tumor cells, judged by proportion aneuploid cells, was markedly higher for trypsin. Using the best cytokeratin antibody for each tumor, two parameter flow cytometry was done (cytokeratin versus DNA content). Enrichment of tumor cells was then tested by measuring the fraction of aneuploid cells (the presumed malignant population) of cytokeratin-positive cells versus all cells. An enrichment factor ranging between 0 (no enrichment) and 1 (perfect enrichment, tumor cells only) was then calculated. The average enrichment was 0.60 for head and neck tumors and 0.59 for esophagus tumors. CONCLUSIONS: We conclude that this method can substantially enrich the proportion of tumor cells in biopsies from carcinomas. Application of this method could significantly enhance accuracy of tumor cell kinetic measurements.

Aneuploidy↗

PubMed1996

A new heat and moisture exchanger with speech valve (Provox stomafilter).

In previous studies investigating the influence of a heat and moisture exchanger on the respiratory and psychosocial problems of laryngectomized patients, the value of regular use of such a device could clearly be established. However, the compliance with the use of these devices was not optimal, mainly due to problems related to the plaster and to the often troublesome combination of these HMEs with a voice prosthesis. Therefore, a prospective, clinical trial was undertaken to investigate whether the use of a newly developed heat and moisture exchanger (HME, Provox stomafilter) could improve the acceptibility of such a device. In total, 19 patients participated in this study, 13 men and six women. Vocal rehabilitation was achieved with a Provox voice prosthesis in all patients. Each of the patients was provided with a supply of HMEs for a 3-week trial period. The results showed that all patients were clearly positive about the valve used for digital occlusion of the stoma. Voicing was considerably facilitated and the intelligibility improved. Problems experienced in previous studies related to the adhesive tape, such as skin irritation, inadequate adherence and loosening of the plaster by coughing or forced expectoration, could be solved by the availability of the different adhesives included in this system.

Adhesives↗

PubMed1996

The effects of thymostimulin on immunological function in patients with head and neck cancer.

Patients with head and neck carcinoma show deficits of cellular immunity, probably due to low molecular mass factors (LMMFs) released by the tumour. Thymostimulin (TP1) restores the defective monocyte chemotaxis and dendritic cell clustering capability in the presence of the tumour when administered pre-operatively. In the present study we investigated these immune parameters in 39 patients treated with TP1 for 10 days pre- and 6 months post-operatively and in 22 patients who were not treated with TP1 for 6 months after operation. Removal of the tumour in non-TP1-treated patients also resulted in a restoration of monocyte and dendritic cell functions, while TP1 treatment gave no additional effect. LMMF levels in the blood of both TP1-treated and non-TP1-treated patients remained elevated even after removal of the tumour, and it is therefore concluded that it is unlikely that depression of cellular immunity is a direct effect of these LMMFS.

Adjuvants, Immunologic↗