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Biomedical subjects

A Sismanis

Publications and source records attributed to A Sismanis.

At least 37 records · Page 2Linked to original sources
PubMed1994

p53 tumor suppressor oncogene expression in squamous cell carcinoma of the hypopharynx.

BACKGROUND: Although abnormalities of the p53 tumor suppressor oncogene system are being detected in many human cancers, the frequency and prognostic significance of such events in squamous cell cancer of the head and neck remain unknown. METHODS: Immunohistochemical studies were performed on archival tumor tissue taken from 43 patients with squamous cell carcinoma of the hypopharynx. Statistical analyses examining potential associations between p53 oncoprotein accumulation and various clinicopathologic parameters (including survival) were conducted. RESULTS: Sixteen (37%) tumors demonstrated strong specific staining for p53. Patients whose tumors stained strongly for p53 were significantly younger, presented at a more advanced clinical disease stage, and tended to have increased expression of epidermal growth factor receptor (P = 0.056). There was no correlation between p53 expression and the incidence of multiple primary cancers, tumor grade, DNA ploidy, or percent of S-phase. Median survival times were 11.6 months and 18.0 months for the p53-positive and p53-negative groups (NS). A Cox regression analysis confirmed the lack of significance of p53 in overall survival. CONCLUSIONS: These data suggest that although abnormalities of the p53 oncoprotein are common in this cancer, this finding is of little clinical significance.

Age Factors↗
PubMed1994

Postoperative radiotherapy improves survival in squamous cell carcinoma of the hypopharynx.

BACKGROUND: Postoperative radiation is considered to be "standard of care" therapy for advanced, resectable squamous cell carcinoma of the head and neck. This approach has been supported by retrospective data but has not been validated in randomized clinical trials. PATIENTS AND METHODS: The present analysis examined the clinical course of 110 patients with squamous cell cancer of the hypopharynx treated with surgery alone (n = 65) and postoperative radiotherapy alone (n = 45) between 1966 and 1990. Staging of patients was performed using the 1988 American Joint Committee on Cancer criteria. Cox regression analyses identified clinical and pathologic factors that were significant for disease-free and overall survival. Crude and adjusted cancer-specific survival rates were calculated. RESULTS: The postoperative radiotherapy group presented with more advanced disease than the surgery alone group (stage III and IV combined, 96% versus 77%, P = 0.015). Crude 5-year cancer-specific survival probabilities were 43% for the postoperative therapy group and 27% for the surgery alone group (P = NS). Adjusted 5-year survival rates, correcting for differences in significant prognostic variables between groups, were 18% and 48%, respectively, for the surgery and postoperative radiotherapy groups (P = 0.029). CONCLUSIONS: The addition of postoperative radiotherapy was associated with improved disease-free and adjusted overall cancer-specific survival in patients with advanced hypopharyngeal squamous cancer. The potential survival benefit of postoperative radiotherapy should be addressed in a randomized clinical trial.

Carcinoma, Squamous Cell↗
PubMed1994

Pulsatile tinnitus: recent advances in diagnosis.

Pulsatile tinnitus can often be a diagnostic problem. This communication reports the authors' experience on 100 patients with pulsatile tinnitus and describes a practical and effective diagnostic approach. Better understanding of the various etiologies of pulsatile tinnitus, coupled with the introduction of magnetic resonance angiography, in conjunction with magnetic resonance imaging, have made a major impact on the evaluation of this symptom in recent years. Cerebral angiography, previously performed on the majority of patients, is presently indicated in selected cases only. Intracranial hypertension, glomus tumors, and carotid atherosclerosis were the most common diagnoses made in our patients.

Adult↗
PubMed1994

Methotrexate therapy for autoimmune hearing loss: a preliminary report.

The management of autoimmune sensorineural hearing loss (SNHL) continues to challenge the otologist. Steroids and cyclophosphamide, the two traditional medications for this malady, are often associated with serious adverse reactions. In an effort to use a less toxic medication, the authors treated five autoimmune SNHL patients with low-dose oral methotrexate. Methotrexate has been found to be very effective in rheumatoid arthritis patients with acceptable adverse reactions. Preliminary results from this study indicate that methotrexate has the potential of being effective for autoimmune SNHL and associated otologic symptoms. Tolerance has been very good and side effects have been minimal.

Administration, Oral↗
PubMed1994

Update of reparative granuloma: survey of the American Otological Society and the American Neurotology Society.

Members of the American Otological Society and the American Neurotology Society were polled regarding stapes surgery and reparative granuloma. Of 467 questionnaires, 176 (38%) were returned, and 319,410 stapes cases were statistically analyzed: 329 reparative granulomas were reported after stapedectomy (incidence = 0.1%) and 29 after stapedotomy (incidence = 0.07%); 77 surgeons reported having encountered at least one reparative granuloma; and 50 surgeons related the occurrence of a reparative granuloma to a specific graft material. Gelfoam was the most common graft material reported when a reparative granuloma was encountered, followed by fat, and vertigo was the most frequently reported presenting symptom. Reported operative techniques as well as manifestations, management, and outcome are discussed.

Adult↗
PubMed1994

Objective tinnitus in patients with atherosclerotic carotid artery disease.

Atherosclerotic carotid artery disease (ACAD) as a cause of objective-pulsatile tinnitus has not been adequately addressed in the literature. This report presents the authors' experience in 12 patients with pulsatile tinnitus arising from ACAD. Ipsilateral carotid bruit was detected in all patients and objective tinnitus was present in eight cases. The intensity of the carotid bruit was louder than the objective tinnitus in all patients. Carotid artery stenosis was confirmed in all patients with noninvasive vascular flow mapping. Atherosclerotic carotid artery disease should be highly suspected in patients with pulsatile-objective tinnitus who are older than 50 years and have associated cardiovascular risk factors. Pulsatile tinnitus in these patients can be the first manifestation of ACAD. Duplex ultrasound study of the carotid arteries can confirm the diagnosis. Consultation with a vascular surgeon is essential in selected cases.

Aged↗
PubMed1993

Epidermal growth factor receptor expression in squamous cell carcinoma of the hypopharynx.

Expression of the epidermal growth factor receptor (EGFR) has been demonstrated in normal and malignant squamous epithelia. Its presence has been suggested to be important in the pathophysiology and prognosis of epithelial cancers. Archival tumour specimens from 57 patients with squamous cell carcinoma of the hypopharynx were studied using OM-11-951, a new murine anti-EGFR monoclonal antibody which recognizes the receptor on deparaffinized tissue. By visual inspection, 28 (49%) tumours were EGFR negative; 29 (51%) tumours were EGFR positive. While patients whose tumours were EGFR positive were younger, there was no significant correlation with other clinical or pathological variables (including grade and stage). Patients whose tumours were EGFR negative had a median survival of 21 (95% CI 4.3-37.7) months compared with a median survival of 17 (95% CI 11.4-22) months for patients whose tumours were EGFR positive. The difference was not statistically significant. A multiple regression analysis did not demonstrate EGFR status to be important in predicting survival. These data cast doubt on the prognostic significance of EGFR expression in this neoplasm.

Antibodies, Monoclonal↗
PubMed1992

Incompletely resected advanced squamous cell carcinoma of the head and neck: the effectiveness of adjuvant vs. salvage radiotherapy.

Between 1982 and 1988, 441 patients were treated at the Medical College of Virginia for AJC Stage III and IV squamous cell carcinoma of the head and neck. We report here on 84 patients whose tumors were incompletely resected based on histopathological margins of 1 mm or less. Of these 84 patients, 49 were treated with surgery alone and 35 received immediate postoperative irradiation to doses of 50-70 Gy. The two patient groups are comparable with respect to stage of disease, age, male/female and racial ratios. This retrospective analysis, based on follow-up of 24-110 months, gives actuarial locoregional tumor control and survival data. The local control and disease-free survival rates in the combined modality group are significantly superior at the p = 0.0006 and p = 0.0003 levels, respectively, relative to the group treated with surgery alone. Patients in the combined modality group also experienced a significantly improved adjusted and overall survival, p = 0.005 and p = 0.01, respectively. The administration of postoperative irradiation was not associated with an increased rate of complications. The benefit of radiotherapy on survival was only seen when given as postoperative treatment but was lost in patients treated for salvage after tumor recurrence.

Adult↗
PubMed1991

Rheumatoid arthritis of the larynx: the importance of early diagnosis and corticosteroid therapy.

Rheumatoid arthritis is a destructive systemic disorder characterized by remissions and exacerbations. The larynx is involved in approximately 25% of these patients. The importance of early detection of laryngeal involvement by this disease and treatment with corticosteroids has not been adequately addressed in the literature. We have described five patients who had early diagnosis and successful treatment with systemic corticosteroids and/or corticosteroid injection of the cricoarytenoid joint.

Adult↗
PubMed1991

Otitis media: the pathogenesis approach. Assessment and treatment of associated upper respiratory tract pathology.

The communication of the middle ear with the nasopharynx via the Eustachian tube makes it susceptible to disease processes of the upper airway. It is therefore necessary for patients with otitis media to have a thorough evaluation of the upper airway for detection and management of any concurrent pathologic condition. This article reviews the various upper respiratory tract pathologic entities associated with otitis media.

Humans↗
PubMed1991

Infantile myofibromatosis of the temporal bone: a case report.

We present the first case of solitary temporal bone infantile myofibromatosis. This benign entity clinically and radiologically resembles a malignant process. Diagnosis is established with biopsy and electron microscopy studies. Local resection is the recommended treatment.

Fibroma↗
PubMed1990

Is there consensus in perilymph fistula management?

A perilymph fistula is an abnormal communication between the inner ear fluids and the middle ear space. This article identifies areas of agreement in perilymph fistula management based upon 167 questionnaire responses from active surgeons of the American Otological Society and the American Neurotological Society. The average respondent performed 4.6 fistula explorations among 197 otologic surgeries (some of these were myringotomies) per year. The following statements represent areas of general agreement. The single most important feature of the history is previous trauma or barotrauma. At present no test can replace clinical judgment; however, despite sound judgment and sophisticated testing, it is very difficult to document the presence or absence of a fistula preoperatively. Most often the diagnosis is based on the total clinical picture: history, physical examination, and laboratory testing.

Ear Diseases↗
PubMed1990

Bilateral spontaneous perilymph fistulae: a diagnostic and management dilemma.

In this article, we present a case of bilateral perilymph fistulae. This entity is rare and always presents a diagnostic problem. Bilateral perilymph fistulae are more common in children and should be suspected when bilateral ear symptoms and congenital temporal bone radiographic anomalies are present. Previous trauma or barotrauma may be absent. When a patient manifests bilateral ear symptoms and a fistula has been identified and repaired in one ear, a second fistula should be suspected in the contralateral ear, especially if the fistula test is positive.

Adult↗