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Biomedical subjects

C J Krause

Publications and source records attributed to C J Krause.

At least 19 recordsLinked to original sources
PubMed1999

Subglottic carcinoma: review of a series and characterization of its patterns of spread.

The rarity of primary subglottic malignancies, along with the varied definitions of the anatomic confines of this region, have limited our understanding of the patterns of tumor spread within the subglottis. We conducted a retrospective chart review to analyze clinical and pathologic data in patients with subglottic carcinoma. A pattern of disease progression was identified, which is defined by the cartilaginous laryngeal framework, with the fibroelastic barriers susceptible to tumor invasion. We conclude that although cartilaginous laryngeal structures are preserved until late in the disease course, the ability of tumors to invade the fibroelastic membranes provides them with an insidious means of escape. Specifically, tumor progression occurs primarily within the paraglottic space and extralaryngeal compartments; the potential for mucosal spread is limited. The lack of mucosal disease in patients whose cartilaginous laryngeal structures are intact may present a facade of normality in patients with advanced disease, and perhaps delay the early diagnosis of subglottic malignancies by physical and radiologic examination.

Adult↗
PubMed1996

Violence in the health care environment.

The rapid rise in the incidence of violence in our society is an increasing risk to all Americans. As violence increases for our patients and in society around us, it becomes an ever greater problem for all health care personnel. The number of threats and violent acts against health care providers has been steadily increasing in recent years. The most effective method of managing violence is to prevent it. A critical step in prevention is in differentiating between an angry individual and a potentially violent individual based on his or her speech, appearance, and behavior. Heightened security and changes in the medical environment are additional ways of preventing violence. Management of a violent incident includes early recognition, de-escalation techniques, and a collaborative effort with security personnel.

Adaptation, Psychological↗
PubMed1996

Unknown primary of the head and neck.

The occurrence of metastases to the cervical lymph nodes from an unknown primary tumour is seen in approximately three to six per cent of patients with cervical adenopathy and the primary tumour commonly remains elusive. Single modality treatment is occasionally advocated but combined treatment seems to obtain the best results. A retrospective analysis of patients' charts with unknown primary of the head and neck in the University of Michigan Medical Center was undertaken for the years 1978-1992. Forty-eight records met study criteria and were reviewed. Our series' size and heterogeneity prevents drawing conclusions regarding treatment effectiveness. The majority (67.5 per cent) of our patients were treated by surgery followed by irradiation. Our overall survival rates compare favourably with the general statistics although it should be noted that longer follow-up in our first group of patients may alter our results. Extracapsular spread did not adversely affect survival in our small series of five cases. We discovered six primary sites within one year and three additional cases within four years. The primary site was included in the radiation fields in all instances of squamous cell tumours that were eventually found. It has been suggested than eventual manifestation of the primary site adversely affects prognosis, which is in agreement with our results.

Adult↗
PubMed1996

Elevated arginine vasopressin levels in squamous cell cancer of the head and neck.

The reported effectiveness of single tumor markers (TMs) associated with squamous cell cancer of the head and neck ranges from 15% to 71%, with most studies reporting sensitivity no higher than 50%. An increased incidence of the syndrome of inappropriate secretion of antidiuretic hormone or arginine vasopressin (SIADH) in patients with head and neck cancer has been reported. Serum arginine vasopressin (AVP) was studied as a possible TM in these patients. Sixty-three patients with squamous cell carcinoma of the head and neck determined as potentially curable were prospectively evaluated before treatment and compared to 17 patients with apparent cure of head and neck squamous cell cancer who served as controls. Serum AVP levels were obtained and determined by radioimmunoassay in the preoperative period and 1 week postoperatively in 15 patients. Thirty-four patients were staged as T4, 26 as T3, and 3 as T2. Twenty-one (33%) of the 63 patients had no neck involvement. Twenty-four (38%) of 63 patients had elevated serum AVP levels corrected for serum osmolarity. Of the 15 patients evaluated before and after surgery, 8 (53%) had elevated serum AVP levels preoperatively. Of these 8 patients, 3 had reduction in AVP levels and 5 had complete normalization after 1 week. The result obtained for serum AVP do not exceed results of other TMs reported. AVP may also not be as specific as other TMs for cancer of the head and neck. Our group with AVP sampled postoperatively is too small for us to draw conclusions, but reduction of its levels after treatment in all patients may be significant. These preliminary results indicate that further evaluation of AVP during the posttreatment course in a larger number of cases, and perhaps with other TMs as well, is warranted.

Adult↗
PubMed1994

Recurrent cytogenetic abnormalities in squamous cell carcinomas of the head and neck region.

We characterized the breakpoints, gains, and losses of chromosome material in squamous cell carcinomas of the head and neck region from 29 patients. Cell lines were karyotyped in 1/3 of cases, direct preparations or early in vitro harvests in 1/3, and both in 1/3 of cases. GTG-banding was employed in all cases, as were C-banding and RBG- and AgNOR-staining in most. Some tumors were near-diploid and others near-tetraploid, but many had mixed populations, with diploid, tetraploid, and octoploid subclones representing essentially the same karyotypic pattern. The most frequent changes were deletions. Losses affecting 3p13-p24, 5q12-q23, 8p22-p23, 9p21-p24, and 18q22-q23 ranged in frequency from 40% to 60% of tumors. Loss of the short arm of the inactive X occurred in 70% of tumors from female patients, and loss or rearrangement of the Y occurred in 74% of tumors from male patients. Loss of 18q appeared to be associated with short survival, as did the presence of multiple deletions. There was gain (2-5 extra copies) of 3q21-qter, 5p, 7p, 8q, and 11q13-q23 in 28-38% of tumors. Three tumors had an hsr involving 11q13-q21. Gain of material at 11q13 is postulated to be associated with amplification of the PRADI/CCND gene at that locus. A translocation between proximal 1p and either an acrocentric short arm or proximal 8p or 9p was observed in squamous cell carcinomas of the head and neck region but not in female genital tract tumors. No other abnormalities appeared to be site specific, suggesting a pattern of genetic evolution in squamous cell carcinoma that is independent of anatomic site.

Adult↗
PubMed1992

Serial studies of autologous antibody reactivity to squamous cell carcinoma of the head and neck.

In previous studies we evaluated the incidence and specificity of autologous antibody reactivity against squamous cell carcinoma of the head and neck (SCCHN). We were able to demonstrate that autologous antibody reactivity is present in native sera but was usually of too low a titer to allow further analysis. Dissociation of immune complexes by acidification and ultrafiltration of serum augmented autologous antibody reactivity in nine out of nine autologous systems tested. Native antibody and antibody derived from immune complexes produced by the host and reactive with autologous tumor cells may be directed against physiologically relevant antigens. Therefore, correlations of antibody titers with clinical course may provide insight into the nature of the host response to cancer. In the present analysis, serological studies of six patients with SCCHN were performed with serum samples obtained over many months. Results of serial serological assays were correlated to tumor progression and clinical course. Fluctuations in autologous antibody reactivity were noted over time. In four cases, rises in autologous antibody titers preceded the clinical diagnosis of recurrence by several months. Drops in autologous antibody reactivity were noted in two cases following surgery or radiation therapy. In two cases of long-term survivors, no correlation between antibody reactivity and clinical course was noted. Specificity analysis of the six autologous systems demonstrated reactivity against autologous and allogeneic SCCHN as well as melanoma cell lines. These sera did not react with glioma, neuroblastoma, renal cell, breast, bladder and colon carcinoma cell lines nor with fetal calf serum, pooled lymphocytes, red blood cells and platelets. Autologous serial serological studies may provide a means by which to evaluate the host/tumor relationship in patients with SCCHN.

Aged↗
PubMed1989

Incidence of serum antibody reactivity to autologous head and neck cancer cell lines and augmentation of antibody reactivity following acid dissociation and ultrafiltration.

Serum antibody reactivity to squamous cell carcinoma of the head and neck (SCCHN) was evaluated in 41 autologous serum-tumor cell line combinations using the protein A hemadsorption assay. Autologous antibody reactivity (median titer of 1:4) was detected in sera from 24 of the patients tested. In 10 cases autologous antibody reactivity could be detected only in undiluted serum precluding further analysis. Analysis of higher titer sera from one patient revealed antibodies that define an antigen expressed on autologous tumor cells cultured from both the primary tumor (UM-SCC-17A) and from a metastasis (UM-SCC-17B). Absorption analysis showed that this antigen was also expressed on 6 of 10 allogeneic SCCHN cell lines but not on autologous fibroblasts or on allogeneic melanoma cell lines. Due to the low titer of autologous antibody reactivity in most sera, we sought to determine if dissociation of immune complexes through acidification and ultrafiltration of serum might enhance detectable antibody reactivity as has been done in previous studies in melanoma. Twelve serum samples from eight patients were subjected to acid dissociation and ultrafiltration (AD-U). Only six of the untreated sera had detectable antibody reactivity against the autologous SCCHN cell line whereas following AD-U all 12 sera had enhanced IgG reactivity against autologous SCCHN. Specificity analysis of one serum sample after dissociation revealed that the antibody detected an antigen common to SCCHN cell lines as well as melanoma, glioma, renal, and colon carcinoma cell lines. Circulating immune complexes may provide a reservoir of antibody with potential diagnostic and therapeutic applications.

Antibodies, Neoplasm↗
PubMed1987

Malignant parotid gland tumors: a retrospective study.

This is a comprehensive retrospective study (1965-1984) of 130 patients with malignant parotid gland tumors. Patients were studied by comparison of presenting symptoms, histopathologies, treatments, disease-free intervals, and ultimate intervals. Facial paralysis was noted on presentation in 23% of the cases and regional neck node metastases were noted in 13%. Both findings correlated with prognosis. Seventy patients underwent surgery alone and 30 patients received combined therapy. The remaining patients were excluded from the study. The overall 5-year survival rate was 50%, with a 44% risk of recurrence. Fifty-six percent of the patients whose conditions subsequently recurred had their facial nerves sacrificed at time of surgery. Selected patients who received combined therapy experienced better local regional control and a prolonged disease-free interval as compared with those who underwent surgery alone. Combined therapy, however, provided no survival benefit for this group of patients. Adjuvant radiation therapy is recommended in the treatment planning of selected malignant tumors of the parotid gland.

Adenocarcinoma↗
PubMed1987

Surgery of the bony and cartilaginous dorsum.

Successful management of the bony and cartilaginous dorsum requires accurate preoperative assessment and surgical planning. Careful management of the dorsum avoids most of the common pitfalls in rhinoplasty and contributes to patient satisfaction.

Cartilage↗
PubMed1986

Surgical treatment of recurrent pleomorphic adenoma of the parotid gland.

Recurrent pleomorphic adenomas of the parotid gland warrant consideration because of the potential for facial nerve injury occurring with surgical treatment and the risk of malignant conversion. Forty-eight cases of recurrent pleomorphic adenoma treated at the University of Michigan, Ann Arbor, between 1935 and 1975 were retrospectively analyzed. The results of surgical procedures for recurrence were determined with respect to tumor control and resultant facial nerve function. Malignant conversion developed in three (6%) of 48 cases. The results of this study underscore the importance of adequate surgical excision of initial recurrences as well as primary tumors to prevent tumor recidivism. Tumor control rates and facial nerve preservation are enhanced with formal parotidectomy for recurrent tumor when feasible. In cases in which facial nerve identification and dissection is not possible, en bloc total parotidectomy offers effective, though not absolute, control of extensive recurrence.

Adenoma, Pleomorphic↗
PubMed1986

Small cell carcinoma of the larynx: results of therapy.

Primary small cell carcinoma of the larynx is a rare malignancy with a dismal prognosis. A survey of the long-term follow-up from reported cases of small cell carcinoma of the larynx and a review of the recent experience with this tumor at the University of Michigan Hospitals was undertaken to determine if newer treatment approaches incorporating adjuvant chemotherapy were associated with prolonged survival. Median survival for those patients receiving adjuvant chemotherapy was 19 months compared to 11 months for patients treated with surgery and/or radiation therapy alone. Among patients treated initially with primary radiation therapy and adjuvant chemotherapy median survival was 55 months, which was significantly longer than any other treatment regimen (P = 0.02). Systemic chemotherapy and therapeutic irradiation appears to offer the least disabling and most efficacious form of current therapy.

Aged↗
PubMed1985

Conservation laryngeal surgery. A critical analysis.

Three hundred forty-two cases of laryngeal cancer were treated at the University of Michigan, Ann Arbor. One hundred ten supraglottic cancers and 150 glottic cancers were studied in depth. Conservation surgery was performed on 63 patients. Determinate two-year disease-free survival for glottic cancer was 90% in those irradiated primarily, 83% for those treated with vertical hemilaryngectomy, and 58% in the group that had total laryngectomy. Supraglottic cancers had a determinate survival rate at two years of 62% for those irradiated primarily, 80% for those treated with a supraglottic laryngectomy, and 62% when total laryngectomy was required. The cost of preserving the respiratory and sphincteric functions of the larynx in some cases amounted to the morbidity associated with a protracted hospital stay, altered deglutition, instances of a weak but functional voice, and the possibility of a permanent tracheostomy. Despite high recurrence rates of 30% to 40%, the overall determinate survival with salvage was an acceptable 80% for the conservation surgery group.

Adult↗
PubMed1985

Intramuscular hemangioma of the head and neck.

Intramuscular hemangiomas are unusual tumors in the head and neck region that occur most frequently in the masseter muscle and are often confused with parotid neoplasms. Four cases are described and the literature reviewed. The diagnosis and management of these tumors are discussed in view of the fact that accurate preoperative diagnosis is unusual and tumor recurrence rates high. Increased awareness of the clinical presentation of intramuscular hemangiomas should enhance diagnostic accuracy and facilitate optimal treatment planning.

Adult↗
PubMed1984

In vitro sensitivity and resistance of cultured human squamous carcinoma cells to cis-platinum and methotrexate.

To determine whether resistance to chemotherapy in advanced head and neck squamous cell carcinoma stems from biochemical mechanisms and to assess the potential usefulness of new anticarcinogens, an in vitro test would be highly desirable. In the past 4 years our laboratory has developed methodology to establish squamous carcinoma cell lines in tissue culture from patients with squamous cancer of the head and neck. We used some of these lines to compare the in vitro effects of methotrexate on squamous carcinoma, fibrosarcoma, and melanoma cells. Three of the squamous carcinoma lines were tested for sensitivity to both methotrexate and cis-platinum; all but one squamous carcinoma cell line exposed to methotrexate showed growth inhibition at the physiologically attainable concentration of 10(-7) M. In contrast, a tenfold higher concentration was required to produce similar effects in the melanoma, while no concentration inhibited fibrosarcoma growth. Cis-platinum showed consistent squamous carcinoma cytotoxicity in 10(-5) M and 10(-6) M concentrations. This approach should be useful for determining the relative sensitivity and resistance of head and neck cancers to chemotherapeutic agents in vitro.

Carcinoma, Squamous Cell↗
PubMed1983

Factors affecting the growth of head and neck squamous carcinoma cell lines.

Cell plating density influences the growth pattern of human squamous cell carcinoma (SCC) cell lines in culture. SCC lines were used to study factors responsible for these effects. Experiments in which the medium was changed daily or in which conditioned medium was used showed that the growth-supporting factors were not found in the media. However, when cells were plated in dishes in which the same cell line had been grown to confluence and removed by scraping, logarithmic growth began immediately. The effect was not seen on areas of the plate that had been covered with coverslips or in dishes where fibroblasts had been cultured. Antibodies to fibronectin, laminin, and a variety of epidermal cell antigens were used to determine the nature of the growth-stimulating substances remaining on the dish following cell removal. Results indicate that an extracellular matrix with similarities to basement membranes was present on the conditioned dishes.

Carcinoma, Squamous Cell↗
PubMed1983

Antibodies to human squamous cell carcinoma.

We are studying membrane antigens of human squamous cell cancer with the use of naturally occurring autologous antibodies from patients' sera, along with a set of other serologic reagents and monoclonal antibodies raised against cultured squamous cell lines. Twenty-eight squamous cell carcinoma cell lines have been established in our laboratory from tissues obtained from 23 patients. Antibody reactivity has been found against the autologous tumor cell line in 13 of 23 patients. One of these is of sufficient titer for detailed analysis. Four cell lines are available from this patient. UM-SCC-17A is derived from the primary laryngeal carcinoma, and UM-SCC-17B is derived from a lymph node metastasis removed during the same surgical procedure. Fibroblasts have been cultured from normal mucosa, and a B-lymphoblastoid line has been developed by Epstein-Barr virus transformation of the patient's peripheral blood lymphocytes. Antibody from this patient reacts with the UM-SCC-17A and -17B tumor cell lines but does not react with the normal fibroblasts (UM-NF-17).

Antibodies, Monoclonal↗