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Biomedical subjects

A J Balm

Publications and source records attributed to A J Balm.

107 records · Page 6Linked to original sources
PubMed1988

The expression of intermediate filaments and mam-6 antigen in relation to the degree of morphologic differentiation of carcinoma of the head and neck: diagnostic implications.

In this study, the immunoreactivity of several cytokeratin antibodies; 115 D8, a monoclonal antibody against MAM-6, an epithelial membrane antigen; and two vimentin antibodies, is examined in relation to the degree of morphologic differentiation in carcinomas of the head and neck. The results indicate that a relationship exists between the degree of morphologic differentiation and the expression of cytokeratin, MAM-6, and vimentin, as detected by polyclonal antikeratin, 115 D8 and anti-vimentin. Expression of cytokeratin and MAM-6 is reversely related to vimentin. Polyclonal anti-keratin; CAM 5.2, a monoclonal antibody against cytokeratin 8, 18 and 19; and 115 D8, used in combination, were still able to identify the epithelial nature of undifferentiated/spindle cells. Since these immunohistochemical markers precede light microscopic detectable signs of epithelial differentiation, they can be used for the identification of the epithelial nature of undifferentiated/spindle tumors of the head and neck.

Antigens, Differentiation↗
PubMed1988

Dacryocystography after paranasal sinus surgery.

The influence of nasolacrimal duct dissection and irradiation of the lacrimal system on lacrimal drainage were assessed. Findings at dacryocystography, in correlation with the results of dye tests and symptoms, are presented. Lacrimal drainage obstruction was demonstrated in one of 10 patients after paranasal sinus surgery not followed by irradiation and in four of 10 patients in which surgery was followed by irradiation.

Adolescent↗
PubMed1988

Antibodies to components of neutrophil cytoplasm: a new diagnostic tool in patients with Wegener's granulomatosis and systemic vasculitis.

Eleven patients with symptoms highly suggestive of Wegener's granulomatosis are described. In spite of extensive investigation, only in two patients was a firm histological diagnosis of Wegener's granulomatosis obtained, while the remaining patients were either diagnosed as having unclassifiable systemic vasculitis or had no histological diagnosis made. This sometimes resulted in diagnostic and therapeutic delay and irreversible organ damage. Antibodies to components of neutrophil cytoplasm--recently demonstrated to be specific for Wegener's granulomatosis--were detected by indirect immunofluorescence in 10 of 11 patients, and it appears likely that antibodies to components of neutrophil cytoplasm will prove to be of great value in early diagnosis.

Adult↗
PubMed1987

Cartilagenous tumours of the larynx.

A brief review of the literature on cartilagenous tumours of the larynx is presented and their pathology, clinical features and treatment is discussed: Chondromas are rare; Chondrosarcomas can be potentially fatal. Conservative surgical therapy and close follow up is the essential line of treatment for tumours of the cricoid cartilage. Three new cases are presented.

Adult↗
PubMed1987

Immunohistochemical detection of retroviral-P15E-related material in carcinomas of the head and neck.

As has been reported previously, head and neck carcinomas produce low molecular weight factors (H/N ca LMWFs); a molecular weight less than 25000 daltons is capable of inhibiting the chemotaxis of mononuclear phagocytes. The effect of the factors could be neutralized by antibodies to P15E, one of the structural envelope proteins of Murine Leukemia Viruses (MuLV). This indicates that these low molecular weight factors derived from the tumors are related to P15E. In this study, 35 biopsy specimens of head and neck carcinomas were subjected to an indirect immunoperoxidase assay, in order for P15E-like material to be detected morphologically. All head and neck carcinomas gave positive results. Sixty-three percent of other carcinomas (used as controls) were positive as well. P15E-like material was also expressed in epithelia-overlaying inflammatory responses. Healthy epithelia were not positive. This report thus supports the view that P15E-like molecules can be easily detected in cancerous disease--not only by way of biologic isolation, but also by use of immunohistochemical techniques. Since the factor is not specific for the malignant state, it cannot be used as a tumor marker. Possibly involved in the pathogenesis of cancerous disease, its relationship to growth factors, oncogenes, and the immune system needs further clarification.

Adult↗
PubMed1986

Defective monocyte chemotaxis in patients with head and neck cancer. Restoration after treatment.

Monocyte chemotactic responsiveness (MCR), as measured by the monocytes' capacity to migrate through polymer (Millipore) membranes toward the chemoattractant casein, is impaired in all patients with head and neck cancer thus far examined. Using a more rapid and sensitive test system, the polarization assay, we tested the MCR in 24 patients with head and neck cancer and 31 controls and compared it with the outcomes of the well-established Boyden chamber method. The results of both methods correlated well. All patients showed a seriously depressed monocyte chemotaxis before treatment when tested in the polarization assay. Nine patients were reexamined after surgery, and in seven patients the defective MCR was restored. This illustrates that tumor-derived factors are probably responsible for the inhibitory effect on monocyte chemotaxis. The polarization assay has the potential for predicting early relapse.

Adult↗
PubMed1986

Intracranial hypertension following neck dissection.

A 51-year-old man developed prolonged papilloedema as a result of increased cerebrospinal fluid pressure following staged bilateral radical neck dissection. The patient recovered completely with no further specific therapy. Although the prognosis for vision is usually good in patients with longstanding papilloedema due to raised cerebrospinal fluid pressure, permanent visual impairment remains a serious complication. In the presence of anatomical variations of the venous pathways by which the blood leaves the brain, a raised intracranial pressure may also develop following unilateral radical neck dissection. Nine cases of increased intracranial pressure following unilateral radical neck dissection reported in the literature until now are briefly reviewed.

Carcinoma, Squamous Cell↗
PubMed1985

Osteomyelitis in the head and neck.

Since the advent of antibiotics osteomyelitis in the head and neck is relatively uncommon and the condition has become a sort of medical curiosity. In the last 16 years, only three cases have been seen by the second author. It is the purpose of this paper to present these cases from our experience and to show that control and cure may only be achieved by early diagnosis, appropriate antibiotic therapy and, where necessary, by radical surgery with the excision of all diseased bone and with prolonged use of antibiotics post-operatively. In cases of diagnostic difficulties the use of scintigraphy is advisable. Established osteomyelitis of the frontal bone necessitates CAT scanning of the cranium to exclude intracerebral extension.

Adult↗
PubMedDate not supplied

Preservation of function by radiotherapy of small primary carcinomas preceded by neck dissection for extensive nodal metastases of the head and neck.

BACKGROUND: When patients are initially seen with a small primary tumor and regional metastases, the question arises whether the primary can be managed by definitive radiotherapy while treating the neck with surgery and postoperative radiation. The advantage of this is least disturbance of the primary site, while still achieving maximal control of the neck disease. METHOD: A retrospective review was conducted over an 8-year period; of the 619 patients seen during this time, 15 were judged suitable for this approach. Small primaries were defined as T1 or T2 lesions or superficial spreading T3 tumors. Extensive neck disease was defined as at least 3 cm in size. RESULTS: There were no regional recurrences and only 3 local recurrences, 2 of which were successfully salvaged. Four patients died of distant metastases. The arguments for and against this unusual approach are discussed. CONCLUSIONS: It is concluded that, in patients conforming to our criteria, this is a sound oncologic approach.

Adult↗
PubMedDate not supplied

Value of resection of pulmonary metastases in head and neck cancer patients.

BACKGROUND: Literature shows no data about a complete cohort of head and neck cancer patients who developed pulmonary metastases. In this study, we investigate factors related to survival, with emphasis on the role of a pulmonary metastasectomy. METHODS: A retrospective review of 138 patients who developed pulmonary metastases (5.5% of all head and neck cancer patients) in the period 1978 to 1994 is presented. In a stepwise regression analysis (Cox), factors were identified related to survival. Also investigated was whether the prognostic value of potential prognosticators differed between the group that underwent metastasectomy and the group that did not. RESULTS: One hundred thirty-eight patients had metastases originating from head and neck cancer. The 5-year survival rate for all these patients was 13%. Younger patients (P = .011), patients with a longer disease-free interval (DFI) (P = .011), patients with a longer disease-free interval (DFI) (P = .016), and patients with a nonsquamous cell carcinoma (P = .038) did better. No evidence of a relationship between survival and sex or survival and number of metastases was found. Twenty-one patients underwent surgical resection of their pulmonary metastases. In 18 patients the resection was complete. The 5-year survival rate for patients who underwent a metastasectomy was 59%, compared with 4% in the nonmetastasectomy group (P = .0033). CONCLUSION: Isolated pulmonary metastases from head and neck cancer are potentially curable by surgical resection. Preconditions for this approach are locoregional control of the primary lesion and technical resectability of the pulmonary metastases. Patients with a long interval between primary treatment and the diagnosis of pulmonary metastases may benefit more from resection therapy.

Aged↗
PubMedDate not supplied

Thymostimulin enhancement of T-cell infiltration into head and neck squamous cell carcinoma.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) produces immunosuppressive low-molecular-mass factors (LMMFs) responsible for defects in the cell-mediated immune system. These defects include impaired monocyte chemotaxis and an impaired capability of dendritic cells (DC) to form cellular clusters. It has been shown previously that the immunomodulating drug thymostimulin (TP1) restores these defects in vitro. METHODS: An immunohistochemical study was performed on tumors of 18 patients with HNSCC who had preoperatively been treated with TP1 in one of three dosages (0.5 mg/kg, 1.0 mg/kg, 2.0 mg/kg body weight). Additionally, tumors of 4 patients who had been treated with a placebo and 12 patients who had not received any preoperative treatment were studied. A relative surface area of infiltration, meaning the percentage of stromal or epithelial tissue covered by infiltrating cells in histological sections, was calculated using an image analysis system (VIDAS RT) for CD3+ T-cells, CD14+/CD68+ monocytes/macrophages and L25+/CD1a+ dendritic cells for each tumor. RESULTS: A highly significant, denser T-cell infiltration into the stromal tissue area of tumors of patients who had been treated with TP1 when compared with tumors of non-TP1-treated patients was observed for all three dosages. None of the other tumor-infiltrating cell types was affected by TP1. In addition, a correlation was found between the tumor T-cell infiltration and capability of DCs in the peripheral blood to form clusters with T-cells. No correlation existed between CD3+ T-cell numbers in peripheral blood and T-cell infiltration into the tumor; nor were monocyte chemotactic functions in peripheral blood correlated with tumor infiltration by monocytes or monocyte-derived macrophages and DCs. CONCLUSIONS: Preoperative treatment of HNSCC patients with TP1 appears to strongly enhance tumor--T-cell infiltration. The number of tumor-infiltrating DCs was not affected by TP1, but a positive correlation between tumor--T-cell infiltration and DC clustering capability suggests that the functional status of DCs is important in improved cell-mediated immunity.

Adjuvants, Immunologic↗
PubMedDate not supplied

Systematic approach to the treatment of chylous leakage after neck dissection.

BACKGROUND: Chylous leakage is an uncommon complication after neck dissection for which several treatment modalities have been described in literature. It occurs in 1% to 2.5% of radical neck dissections, with the majority (75% to 92%) being on the left side. In a consecutive series of patients, we investigated the effect of a systematic approach to the complication. METHODS: Over a period of 5 years, the drain production of 221 patients who underwent a neck dissection was analyzed. One hundred thirty-two right-sided and 139 left-sided neck dissections were performed. In 11 patients a chyle fistula occurred, 1 right-sided and 10 lift-sided. In all cases closed vacuum suction drainage was continued and dietary modifications (medium-chain triglycerides [MCT]/Peptison nasogastric tube feeding [PNTF]) were made. RESULTS: In 5 patients dietary modifications were sufficient to stop the leak. In the other 6 patients total parenteral nutrition via the subclavian vein (TPN) was started. In 2 cases with a severe intractable hypoalbuminemia, surgical intervention was necessary. The leak was closed by a pectoralis major muscle flap transfer, after local application of fibrin sealant (Tissucol). CONCLUSIONS: Chylous leakage is a controllable complication after neck dissection for which is most cases a stepwise conservative approach consisting of dietary modifications, maintaining closed vacuum suction drainage, seems to be sufficient. Hematologic and serum values should be monitored very carefully and corrected appropriately. To initiate planned postoperative radiotherapy in a timely fashion, the conservative treatment should be limited to about 30 days.

Adult↗
PubMedDate not supplied

Supraglottic laryngectomy with postoperative radiation versus primary radiation in the management of supraglottic laryngeal cancer.

PURPOSE: The purpose of this review was to study the results of horizontal partial laryngectomy (HPL) for supraglottic laryngeal cancer (stages N0 and N+) and the effects and morbidity of postoperative radiation therapy (RT), especially after bilateral neck dissection, as opposed to primary RT. PATIENTS AND METHODS: Of a total of 89 patients, 26 were treated by HPL, 44 by primary RT, and 19 by total laryngectomy (TL). Of the HPL patients, 19 of 26 had neck dissection, 10 were bilateral. Twelve of the patients received postoperative RT, and 10 of 12 procedures were combined with neck dissection. RESULTS: When comparing the results of HPL and primary RT, the locoregional control was equivalent for the N0 patients, but HPL showed better results in locoregional control for the N+ patients (P < .0024). Postoperative RT with or without bilateral neck dissection did not show an increase in postoperative morbidity. CONCLUSION: Therefore, our data suggest that there should be no hesitation in giving postoperative RT where indicated, after performing HPL plus unilateral or bilateral neck dissection. Patients that are stage N0 should receive primary RT.

Humans↗
PubMedDate not supplied

Long-term results of concurrent polychemotherapy and radiotherapy in patients with stomal recurrence after total laryngectomy.

From 1978 through 1985, eight patients with stomal recurrence after total laryngectomy were treated with a combination of a cytotoxic regimen (vincristin sulfate, bleomycin, and methotrexate [VBM]) and radiotherapy. The essential feature of this combination is the synchronous administration of pulses of VBM and fractionated doses of external radiotherapy in order to achieve potentiation of radiotherapy. On average, four to five pulses of VBM were given. Severe mucositis is the main problem during treatment. Two patients needed nasogastric tube feeding, and treatment was carried out as an inpatient procedure. Five patients are alive with complete local remission at 7 years, 3 years, 2 1/2 years, 14 months, and 8 months after treatment. These results appear to be spectacular, even though the number of patients is small. Of the three patients who died, only one had recurrent disease around the tracheostoma. The two other patients were free of disease in the neck when they died 6 and 16 months after treatment of, respectively, lung metastases and a second primary tumor in the lung. Patients with stomal recurrence after total laryngectomy are now routinely treated with synchronous VBM and radiotherapy.

Aged↗