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Biomedical subjects

B M Lippert

Publications and source records attributed to B M Lippert.

At least 37 records · Page 2Linked to original sources
PubMed2002

Number and location of radiolabeled, intraoperatively identified sentinel nodes in 48 head and neck cancer patients with clinically staged N0 and N1 neck.

The value of sentinel node (SN) biopsy for squamous cell carcinoma of the head and neck (HNSCC) has not been determined yet. A critical evaluation of this concept seems to be mandatory with regard to the increasing acceptance of SN biopsy in other tumor entities. Against the background of the results of 48 previously untreated patients, a reproducible technique for SN biopsy in the head and neck level, which has been adjusted to the special topographic conditions of this anatomic region, is presented. Methods included intraoperative SN biopsy, which was performed in 48 previously untreated patients suffering from squamous cell carcinoma (2x lower lip, 8x oral cavity, 20x oropharynx, 15x larynx, 3x hypopharynx). Using ultrasound imaging, 43 patients were staged as N0 necks, and 5 patients were staged as N1 necks. Fine-needle aspiration cytology (FNAC) was performed in cases of doubt. Surgery on the neck was carried out according to the suspected stage of lymphogenic spread once the SN1 as well as one or two further hot nodes (SN2, SN3) had been identified. Numbers and distribution of the intraoperatively excised nodes SN1-3 were documented according to their relation to the tumor location. Post-operatively, the histologic results of the intraoperatively excised nodes SN1-3 were compared to the histologies of the neck dissection specimen. Results showed that in all 48 patients, a SN1 could be identified intraoperatively. In 20 cases an additional SN2 and in 6 cases a SN3 was diagnosed. In carcinomas of the lower lip and oral cavity, the SN1 was found in 4 cases in level I (2x lower lip, 2x floor of the mouth) and in 6 cases in level II (6x lateral tongue). In carcinomas of the oropharynx, the respective nodes were found in 17 of 20 cases in level II (carcinomas of the tonsil) and in 3 cases in level III (carcinomas of the base of the tongue). In supraglottic carcinomas the SN1 was identified in 8 of 10 cases in level II and in 2/5 patients with glottic carcinomas, while in 3/5 glottic carcinomas as well as in all hypopharyngeal carcinomas, the SN1 was found in level III. In relation to the predictiveness of the detected SN, it has to be remarked that in 38 patients a SN1 free of tumor was representative for the regional lymph node status (pN0). An isolated metastasis (pN1) was diagnosed in the SN (9x SN1, 1x SN2) in 10 patients. In conclusion, the results of a SN biopsy modified to a strictly intraoperative method of detection are encouraging. Critical indications showed that a thorough and standardized technical performance of the injection as well as a mandatory, so far unchanged, neck dissection form the basis for the development of a SN concept for SCCs of the upper aerodigestive tract. The value of the SN concept, however, currently remains unclear for patients suffering from HNSCC.

Adult↗
PubMed2002

[The sentinel node concept in head and neck squamous cell carcinoma--a critical analysis in 100 patients].

BACKGROUND: The value of Sentinel Node (SN) concept is a current issue in clinical oncology. Few investigations deal with SN biopsy in head and neck squamous cell carcinomas (HNSCC). For this reason the SN concept was investigated based on the results of the so far largest group of 100 patients. METHOD: Three groups of patients were investigated. Group 1: In 30 patients (6 x oral cavity, 24 x oropharynx) a dynamic lymphoscintigraphy was performed. Group 2: 60 previously untreated patients (12 x oral cavity, 23 x oropharynx, 16 x larynx, 9 x hypopharynx); neck lymph node status on ultrasound imaging: 39 x N0, 5 x N1, 16 x N2, intraoperative identification of the SN during neck dissection (ND) accomplished according to the extent of assumed lymphogenic metastatic spread; postoperative comparison of the histological result of the SN with the neck dissection specimen. Group 3: 10 previously treated patients (1 x oral cavity, 5 x oropharynx, 1 x larynx, 3 x hypopharynx) in whom an intraoperative SN biopsy was performed. RESULTS: Group 1: In 20/30 patients a cervical lymph drainage could be visualized on dynamic lymphscintigraphy and an activity enrichment above the mean metastatic region could be identified transcutaneously. Group 2: In 34 patients the tumorfree SN1 reflected the regional lymph node status. In 9 patients an isolated tumor metastasis (pN1) was found in the intraoperatively identified SN1 and in a further patient in the SN2 (pN1). CONCLUSION: The results of SN biopsy are encouraging in cases of clinical N0-necks. Nevertheless the data demonstrates that extensive investigations followed by a critical analysis of the results are required. The presented results suggest that the value of the SN concept seems to be of minor importance in cases of advanced lymphogenic metastatic spread.

Adult↗
PubMed2002

Follow-up with serum Cyfra 21-1 in patients with squamous cell carcinomas of the head and neck.

OBJECTIVE: Finding tumor markers for disease progression, and especially development of distant metastases, is desirable for patients with squamous cell carcinoma of the head and neck (SCCHN). Elevated serum levels of Cyfra 21-1 (cytokeratin fraction 21-1) have been frequently associated with disease progression in patients with lung cancer. In SCCHN, Cyfra 21-1 has not been established as a routine tumor marker yet, probably due to difficulties in finding the appropriate cut-off for the serum level. The aim of this study was to investigate whether assessment of changes in serum Cyfra 21-1 over time can predict distant metastases in patients with SCCHN, without attempting to establish an arbitrary cut-off for abnormal levels. METHODS: Cyfra 21-1 serum levels of 25 patients with SCCHN and distant metastases were evaluated by means of an ELISA test kit. RESULTS: There was a wide range of Cyfra 21-1 serum levels at the time of primary diagnosis, without correlation with tumor size, lymph node status, time to recurrence, or presence of distant metastases. All patients had a clear increase of Cyfra 21-1 levels which preceded the appearance of distant metastases clinically. CONCLUSIONS: Due to the wide range of Cyfra 21-1 levels at the time of primary tumor diagnosis, Cyfra-21-1 is neither a suitable screening marker for SCCHN, nor for diagnosis of distant metastases at the time of initial diagnosis of the tumor, but is of evident prognostic value for follow-up, especially for early detection of distant metastases.

Antigens, Neoplasm↗
PubMed2002

Mycosis fungoides of the larynx: case report and review of the literature.

Mycosis fungoides is a rare cutaneous lymphoma. Dissemination to extra-cutaneous sites occurs at advanced stages of disease. Laryngeal manifestations of mycosis fungoides have been reported in only 13 cases in the available literature. We present a further calla of mycosis fungoides of the larynx at the terminal stage of disease with an additional manifestation in the left maxillary sinus and review the cases published to date. To our knowledge this is the first reported case of mycosis fungoides with laryngeal and paranasal sinus manifestation. Concluding from the present case and from literature therapy should be palliative to improve quality of life.

Aged↗
PubMed2002

Lipoma of the larynx. Report of 2 cases and review of the literature.

Among the primary mesenchymal tumors of the hypopharynx and larynx lipomas are very rare, as they often look macroscopically like retention cysts. Up today approximately 112 cases have been described in literature. We present two further cases of laryngeal lipomas, which were removed endoscopically and by an external approach. Both patients were free of local recurrence.

Adult↗
PubMed2001

Experimental and clinical results of Er:YAG laser stapedotomy.

BACKGROUND AND OBJECTIVE: At the beginning of the 1980s, different laser types were used for stapes surgery to reduce potential harm to inner ear structures through manipulation with conventional instruments during stapedotomy. Most clinical studies were carried out with the CO2 or the argon laser. The Er:YAG laser has been used rarely in patients with otosclerosis. STUDY DESIGN/MATERIALS AND METHODS: In an experimental study on 54 human petrous bones, the optimal laser energy parameter for dissection of the posterior stapes crus and the footplate perforation were determined. With these parameters, stapedotomy was carried out with the Er:YAG laser in 29 patients with otosclerosis with a conventional dissection of the incudostapedial joint and the stapedius muscle tendon. The Er:YAG laser was used (60 or 100 mJ, 3-6 pulses) for dissection of the posterior stapes crus and footplate perforation. RESULTS: No intra- or postoperative complications were observed in all 29 patients. Vertigo and hearing loss were not observed intra- or postoperatively. The postoperative hearing results (improvement of the air-bone gap) was in all cases satisfactory (median remaining air bone gap, 8.1 dB). The median operation time was 29 minutes (15-42 minutes) and did not show a significant prolongation in comparison to the conventional technique. In 1 of the 29 patients, the footplate perforation needed to be carried out conventionally. CONCLUSION: For the first time, Er:YAG laser parameters have been optimized and refined in a human petrous bone model and were then used in a clinical setting. According to the presented results, the Er:YAG laser seemed to be a very suitable instrument for stapedotomy.

Adult↗
PubMed2001

Ultrasound-guided piezoelectric extracorporeal shock wave lithotripsy of parotid gland calculi.

PURPOSE: The introduction of piezoelectric extracorporeal shock wave lithotripsy (ESWL) has changed therapy for salivary calculi. This method seems especially suitable for treating calculi in the parotid gland. The purpose of this study was to evaluate ESWL in patients with such calculi. METHODS: From November 1990 to November 1999, all patients with sialolithiasis of the parotid gland were treated with piezoelectric ESWL. Three different lithotriptors were used over the 9-year study period. Results were analyzed according to both the patients' clinical status and follow-up sonograms. RESULTS: In total, 42 patients (21 women, 21 men; mean age, 59 years) were treated with ESWL. The mean follow-up period for all patients was 63 months (range, 7-96 months). After ESWL had been performed, 71% of the patients were completely free of symptoms, and 21% had marked improvement of their symptoms. Sixty-seven percent were completely free of calculi, and 27% had a marked reduction in the size of their calculi. Adverse effects of ESWL included temporary glandular swelling (4 patients), blood-tinged salivary secretions (9 patients), petechiae on the skin surface (3 patients), and parotid abscess (1 patient). CONCLUSIONS: ESWL is an outpatient procedure that can be performed without anesthesia and with scarcely any discomfort for patients. Conventional surgical procedures such as subtotal parotidectomy may be almost entirely replaced by ESWL because of the excellent treatment results and a very low rate of complications associated with ESWL. ESWL should be considered the treatment of choice for parotid calculi.

Adult↗
PubMed2001

Current concepts in the classification, diagnosis and treatment of hemangiomas and vascular malformations of the head and neck.

There are many different classifications of vascular anomalies. As the correct classification of the vascular lesion has a direct influence on therapy it is difficult to decide which treatment should be considered as the treatment of choice. Based on an extensive review of the literature and personal experience of the treatment of more than 200 patients with hemangiomas or vascular malformations of the head and neck, a clinical classification is described that allows vascular lesions to be categorized in order to plan purposeful treatment. In general, hemangiomas represent the main group of vascular lesions in infancy and childhood. They are usually apparent a few weeks after birth and are characterized by an initially rapid growth of epithelial cells, followed by spontaneous involution. Hemangiomas should be differentiated from vascular malformations that are present at birth but may not be evident clinically. Spontaneous involution of vascular malformations has never been reported, whereas laser therapy can induce involution of hemangiomas at an early stage in a majority of cases. In certain situations steroids or surgical removal may seem to be the appropriate therapy of choice. In contrast, vascular malformations have to be treated according to their histopathology and location, as well as their hemodynamic features as shown radiographically with angiography. The accurate diagnosis of vascular anomalies is essential for further treatment, as shown by clinical experience at the University of Marburg.

Arteriovenous Malformations↗
PubMed2001

Transcriptional repression of the human fibronectin gene in laryngeal squamous cell carcinoma cells.

PURPOSE: The aim of the experiments was to analyze the mRNA expression pattern and verify the repression of FN gene expression in laryngeal squamous cell carcinoma (SCC) cells in comparison with benign mucosal keratinocytes. METHODS: Messenger RNA from SCC cells and benign keratinocytes was reverse transcribed and subjected to PCR following differential display (DD) analysis of the amplicons. Northern hybridization was carried out to confirm the reduction of the FN-mRNA expression in both laryngeal SCC cells and larynx carcinoma biopsies, in contrast to adjacent normal mucosa. Quantitation of protein synthesis was performed with homogenates of fresh tumor biopsies and their normal phenotypes, as well as of benign keratinocytes and laryngeal SCC cell lines, respectively, using ELISA. In the liposome-mediated transient transfection assay, FN promoter activity was analyzed by linking the FN promoter sequence to the chloramphenicol acetyltransferase (CAT) reporter gene. Transfection efficacy was monitored by co-transfection with pGL3 control vector. RESULTS: A 191 bp mRNA fragment revealing a 99% homology with the human FN-mRNA was detected, the expression of which was repressed 20 times as much in SCC cells as compared to benign phenotypes. Northern hybridization confirmed the distinctly reduced expression of FN-mRNA in both laryngeal SCC cells and larynx carcinoma biopsies, in contrast to adjacent normal mucosa. The quantitation experiments showed a correlation between the range of FN synthesis and the expression of FN-mRNA in cell lines and the biopsies which were used. The 1.28 kb FN gene promoter drove expression of the CAT reporter gene, which was similar to the FN-mRNA expression showed by DD and Northern hybridization. CONCLUSIONS: The mechanisms leading to the low level of FN in many tumors have not yet been sufficiently investigated. Our findings suggest that the decrease of FN in laryngeal SCC cells is transcriptionally regulated.

Base Sequence↗
PubMed2001

Value of sentinel lymphonodectomy in head and neck cancer patients without evidence of lymphogenic metastatic disease.

OBJECTIVE: Only few communications deal with the value of sentinel node (SN) biopsy for head and neck squamous cell carcinoma (HNSCC). Based on the results of 38 investigated patients with clinically N0-neck the feasibility of SN biopsy in HNSCC is critically discussed. PATIENTS AND METHODS: Thirty-eight previously untreated patients with clinically N0-neck were staged by intraoperative SN biopsy. After intraoperative identification of the hottest node (SN(1)) and further less tracer accumulating lymph nodes (SN(2), SN(3)), patients were treated by different types of neck dissection (ND), adjusted to the location and extent of the primary tumour. Postoperatively the histologic results of the SN(1-3) and the entire ND specimen were compared. RESULTS: The stage of cervical metastatic disease was demonstrated by a disease-free SN(1) in 32 patients. In five patients an isolated metastasis could be proven in the intraoperatively identified SN(1), while in the remaining patient an isolated metastasis was found in the SN(2). CONCLUSION: Intraoperative SN biopsy seems to be valuable for the detection of occult lymph node metastases in HNSCC. This method might help to limit the extent of ipsilateral ND, if used as an intraoperative staging procedure to investigate the first draining tracer accumulating lymph nodes (SN(1-3)).

Adult↗
PubMed2001

Steroid hormone receptors in parotid gland cystadenolymphoma (Warthin's tumour).

The aetiopathogenesis of cystadenolymphoma is mostly unknown. Cystadenolymphomas have a significantly higher incidence in the male than the female population. This might be as a result of endocrine dependency in this kind of tumour. The purpose of the present study was to determine the sex hormone receptor status in cystadenolymphoma. Tissue samples of cystadenolymphoma, pleomorphic adenoma and normal samples of the parotid gland were examined immunohistochemically for oestrogen and progesterone receptors. Progesterone-positive cells could be found in the salivary duct system of normal glands and in the epithelial components of cystadenolymphomas. There was no evidence for the presence of oestrogen receptor in any sample studied. The evidence of progesterone receptors in cystadenolymphoma may implicate a potential role of endocrine factors in the development of this tumour.

Adenolymphoma↗
PubMed2000

[Treatment of the hypertrophic inferior turbinate. 1].

Chronic nasal obstruction is a common disorder, mostly caused by hypertrophied inferior turbinates. If there is inadequate response to conservative medical management, the inferior turbinates should be reduced. The choice of treatment is mainly influenced by whether the nasal airway obstruction is due to hypertrophic mucosa or to an enlarged turbinate bone. The first part of this review describes the various surgical modalities for treatment of swelling of the turbinal mucosa. The indications, advantages, disadvantages, complications, and controversies of each modality (submucous diathermy, cryosurgery, infra-red coagulation, argon-plasma coagulation, radiofrequency, laser surgical techniques) are reviewed and discussed.

Chronic Disease↗
PubMed2000

[Treatment of the hypertrophied inferior turbinate. 2].

The surgical management of enlarged inferior turbinates has been actively debated for more than a century. The second part of this review describes the following techniques: laterofracture, submucous turbinectomy, concho-antropexy, partial turbinectomy, anterior turbinectomy, inferior turbinoplasty, total turbinectomy, and vidian neurectomy. Indications, advantages, disadvantages, complications, and controversies of each treatment modality are reviewed and discussed. Partial or submucosal resection should be preferred, because there are moderate side effects and the amount of turbinate excised can be altered according the degree of symptomatology. Total turbinectomy or vidian neurectomy are indicated if all other treatment attempts do not succeed.

Humans↗
PubMed2000

Monoclonal antibodies against squamous cell carcinoma of the upper aerodigestive mucous membranes.

BALB/c mice were immunized with viable cells from human squamous cell carcinoma (SCC) cell lines derived from maligant tumors of the upper aerodigestive tract. Hybridomas were selectively grown for the production of monoclonal antibodies. About 700 hybridoma clones produced antibodies that were tested for immunoreactivity in frozen sections of human SCC and hyperplastic tonsils. Monoclonal antibodies produced by the hybridoma clone K-640 were strongly accumulated at the cell membrane of SCC cells, whereas no immune reaction was detected in the squamous epithelium of the tonsil. This study describes cloning and recloning of the K-640 clone, which enabled further enhancement of the antigen specificity. The antibodies of this highly selected clone belong to the IgM class, as shown by isotype determination with an ELISA. Immunoblotting exhibited that the antibodies recognized an antigen with an approximate molecular weight of 55 kD.

Animals↗
PubMed2000

[Transoral treatment of severe laryngomalacia. Review and presentation of a modified surgical technique].

BACKGROUND: Laryngomalacia is the most common cause of stridor in children. So far various authors have described surgical techniques in a sense of a supraglottoplasty or an epiglottoplasty to handle the severe form of this disease. We present a modified technique of the so called epiglottopexy. METHODS: Under the different types of laryngomalacia this study focuses on the treatment of three patients (5 to 10 months) with a posterior displacement of the epiglottis during inspiration. The first step of our technique was to denude a small portion of the base of the tongue from mucosa. A corresponding lesion was created on the lingual surface of the epiglottis. The vaporisation of the mucosa was performed with the CO2 laser at a power setting of 1 Watt and a 0.25 mm spot size. The epiglottis was then fixed transorally to the base of the tongue with 2 single stitch sutures and 1 inverse mattress suture, using a resorbable material. RESULTS: No intra- or postoperative complications were observed. All three patients demonstrated a significant airway improvement without stridor. CONCLUSION: The presented technique of transoral laser surgical epiglottopexy seems to be a method suitable for the treatment of laryngomalacia caused by posterior displacement of the epiglottis.

Age Factors↗