Biomedical subjects

David J Terris

Publications and source records attributed to David J Terris.

At least 37 records · Page 2Linked to original sources

PubMed2004

Carcinoma of the hypopharynx.

Despite advances in surgical and nonsurgical treatment, overall survival rates for patients who have hypopharyngeal carcinoma have not improved,and this disease still has a poor prognosis. The best results are obtained with multimodality therapy. but at best, two thirds of patients are palliated rather than cured of disease. Radical surgery with postoperative radiation therapy remains the standard of care. Organ preservation strategies have not been as successful in hypopharyngeal cancer as for cancers of other head and neck sites. Chemoradiation is an effective alternative method of aggressive treatment but may be associated with significant dysfunction of the end organ when preservation is possible. Because of poor long-term survival rates, local control remains the most important factor in planning treatment, to provide meaningful palliation and best possible quality of life.

Combined Modality Therapy↗

PubMed2004

Endoscopic neck surgery: resection of the submandibular gland in a cadaver model.

OBJECTIVES/HYPOTHESIS: The objective was to evaluate the feasibility of performing a totally endoscopic resection of the submandibular gland in a cadaver model. STUDY DESIGN: Prospective, nonrandomized experimental investigation in a cadaver model. METHODS: A modified endoscopic surgical approach (representing a hybrid of balloon dissection and low-pressure carbon dioxide insufflation) previously developed in a porcine model was implemented in fresh cadavers. Once a reliable protocol was achieved, eight procedures were performed in six cadavers. Data collected prospectively included the operative time, inadvertent neurovascular injury, and size of the glands. RESULTS: All eight endoscopic submandibular gland resections were successfully performed in six consecutive cadavers (no conversions to open resection were necessary). The duration of the procedures ranged from 50 to 150 minutes, with a median duration of 65.5 minutes and a steady trend toward a shorter duration. Histological examination confirmed the presence of normal glandular architecture without evidence of excessive trauma or thermal injury. The optimal spacing of the instrument ports was 4 cm from the camera port. There were no cases of neurovascular injury. In two cadavers, a minimal amount of subcutaneous emphysema could be appreciated, which was limited to the skin overlying the dissection. CONCLUSION: Totally endoscopic resection of the submandibular gland is possible by combining balloon dissection with low-pressure carbon dioxide insufflation. The excellent visualization afforded by the endoscope provided a safe operative approach. Ultimately, a number of endoscopic neck procedures may be possible, and clinical trials are under way.

Cadaver↗

PubMed2004

Prospective evaluation of endoscopic approaches to the thyroid compartment.

OBJECTIVE: To compare a number of endoscopic approaches to the thyroid compartment. DESIGN: Prospective, nonrandomized, experimental investigation in a porcine model. METHODS: We performed a consecutive series of 13 endoscopic thyroidectomies using 5 distinct approaches. The procedures differed by the direction of the approach, incision placement, and use of facilitative maneuvers. The parameters assessed included procedure duration, estimated blood loss, heart rate, blood pressure, temperature, oxygen saturation, and arterial blood gas levels. The thyroid specimens were weighed and examined histologically. RESULTS: Four of the endoscopic approaches were successfully used for resection of the thyroid (12 of 13 animals). The mean operative times were as follows: superior approach (n = 4), 47 +/- 14.6 minutes; lateral axillary approach (n = 4), 67 +/- 11.8 minutes; and superficial axillary (n = 3), 67.7 +/- 22.3 minutes. The one axillary approach took 84 minutes. The precordial approach (n = 1) lasted 47 minutes and then required open conversion. The overall median estimated blood loss was 0 (range 0-100) mL. The mean change in blood pressure and pH from the beginning to the end of the procedure was -0.5 +/- 24.1 mm Hg and 0.16 +/- 0.07, respectively. The thyroid glands weighed 4.3 +/- 0.9 g and had normal glandular architecture with no evidence of significant tissue trauma or thermal injury. There were no cases of pneumothorax, subcutaneous emphysema, or air embolism. CONCLUSION: A number of approaches to the thyroid compartment are conceivable. The superior approach proved to be the fastest and easiest, whereas the lateral axillary and superficial axillary were the best approaches from a cosmetic and clinical standpoint.

Animals↗

PubMed2004

Percutaneous tracheostomy: don't beat them, join them.

OBJECTIVES: The introduction of percutaneous tracheostomy (PercTrach) has resulted in tension over the scope of practice between otolaryngologists and pulmonary/critical care (PCC) specialists. We sought to determine the value of a collaborative approach to the performance of PercTrach at the bedside in the intensive care unit setting. STUDY DESIGN AND METHODS: A retrospective study of consecutive patients who underwent bedside PercTrach at the Medical College of Georgia between May of 2003 and November of 2003. All cases were performed in conjunction with the PCC team, which typically provided bronchoscopic guidance during the performance of the procedure, whereas the PercTrach was performed by the otolaryngology team, although these roles were occasionally reversed. In all cases, the PercTrach was performed using the Ciaglia Blue Rhino introducer set. RESULTS: Twenty-three patients (12 males, 11 females) with a mean age of 47.6 +/- 14.3 (range 23-65) years underwent PercTrach. The procedural times ranged from 7 to 21 minutes, with a mean of 13.9 +/- 4.4 minutes; this represented 9.6 minutes on average to insert the tracheostomy tube and an additional 4.3 minutes to completely secure the tracheostomy tube. The time interval from consultation to PercTrach was less than 24 hours in 16 of 23 cases (overall mean time to PercTrach = 41.7 +/- 37.1 hours), with delays beyond 24 hours related in most instances to patient stability. CONCLUSION: A multidisciplinary approach to PercTrach results in a number of clinical and educational benefits. Chief among these benefits is a rapid, cost-effective response to requests for elective tracheostomy. Practicing otolaryngologists with a prior bias against this approach (as we had) should reconsider adopting this revised procedure.

Adult↗

PubMed2004

Head and neck cancer in transplant recipients.

PURPOSE OF REVIEW: Transplant recipients have an increased incidence of cancer compared with the general population. Head and neck sites are involved in more than 50% of patients, and as a result the otolaryngologist should be familiar with the diagnosis and management of posttransplant malignancies. RECENT FINDINGS: Skin cancer is the most common malignancy encountered in the transplant population, and in areas of high sun exposure, as many as 80% of patients are affected. Patients who undergo liver transplantation for alcoholic cirrhosis appear to be at particularly increased risk for developing posttransplant malignancy of the head and neck. A number of uncommon malignancies such as Kaposi's sarcoma occur with a greatly increased incidence in transplant recipients. Malignancy in this patient population tends to present at a younger age compared with the general population, with a more aggressive course and poorer outcomes reported. SUMMARY: A high index of suspicion may reduce morbidity and mortality through early detection of malignant disease in the transplant recipient.

Carcinoma, Merkel Cell↗

PubMed2004

Surgical robotics in otolaryngology: expanding the technology envelope.

PURPOSE OF REVIEW: Surgical robotics arose as an extension of virtual reality and robotic technology developed by the United States Department of Defense. Current surgical robotic systems have been used to perform a variety of minimally invasive surgical procedures. RECENT FINDINGS: The Food and Drug Administration recently granted approval for the clinical use of two surgical robotic systems. Laboratory and clinical experience suggests that the use of surgical robotics is associated with some distinct advantages and disadvantages when compared with conventional open procedures. Robotic surgery has recently been described in the head and neck, and as a result the otolaryngologist should have a basic understanding of the potential applications of surgical robotics in head and neck surgery. SUMMARY: Surgical robotic technology is evolving but appears to have a distinct place in the surgical armamentarium.

Animals↗

PubMed2003

Long-term outcomes after external beam irradiation and brachytherapy boost for base-of-tongue cancers.

PURPOSE: To assess long-term efficacy and toxicity associated with external beam irradiation (EBRT) and interstitial (192)Ir implantation for the treatment of squamous carcinoma of the base of tongue. METHODS AND MATERIALS: Between April 1975 and December 1993, 41 patients with base-of-tongue carcinomas were treated with (192)Ir interstitial implants after EBRT at Stanford University. One patient had Stage I, 6 had Stage II, 7 had Stage III, and 27 had Stage IV tumors. Twenty-eight patients had cervical lymph node involvement at diagnosis. All received EBRT to a median dose of 50 Gy (range 48.9-68 Gy) to the primary tumor and regional lymph nodes before brachytherapy. Interstitial implant was performed 2-4 weeks after EBRT. Intraoperatively, nylon catheters were placed via steel trocars into the base of tongue, glossotonsillar groove, and pharyngo-epiglottic fold using a catheter looping technique. Twenty-three of 28 node-positive patients also underwent simultaneous neck dissections. Postoperatively, the (192)Ir seeds were inserted and allowed to remain in place for approximately 35 h to achieve a median tumor dose of 26 Gy (range 20-34 Gy) to a median volume of 73 cc. Survival, local control, and complications were assessed. RESULTS: With a median follow-up of 62 months (range 9-215) for all patients and 90 months for alive patients, the 5-year Kaplan-Meier survival estimate was 66%. The 5-year local control rate was 82%, with 7 patients recurring locally, 2 of whom were salvaged with surgery. Nodal control was achieved in 93% of patients with either EBRT alone or in combination with neck dissection. The 5-year freedom from distant metastasis rate was 83%. Acute complications included transient bleeding (5%) and infection (8%). Late complication included soft-tissue necrosis/ulceration (7%), osteoradionecrosis (5%), and xerostomia. CONCLUSION: Base-of-tongue carcinoma can be effectively treated with EBRT and (192)Ir implant boost. Local control is excellent and complication rates are acceptable.

Adult↗

PubMed2003

Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma.

PURPOSE: Treatment of nasopharyngeal carcinoma using conventional external beam radiotherapy (EBRT) alone is associated with a significant risk of local recurrence. Stereotactic radiosurgery (STR) was used to boost the tumor site after EBRT to improve local control. METHODS AND MATERIALS: Forty-five nasopharyngeal carcinoma patients received a STR boost after EBRT at Stanford University. Seven had T1, 16 had T2, 4 had T3, and 18 had T4 tumors (1997 American Joint Commission on Cancer staging). Ten had Stage II, 8 had Stage III, and 27 had Stage IV neoplasms. Most patients received 66 Gy of EBRT delivered at 2 Gy/fraction. Thirty-six received concurrent cisplatin-based chemotherapy. STR was delivered to the primary site 4-6 weeks after EBRT in one fraction of 7-15 Gy. RESULTS: At a medium follow-up of 31 months, no local failures had occurred. The 3-year local control rate was 100%, the freedom from distant metastasis rate was 69%, the progression-free survival rate was 71%, and the overall survival rate was 75%. Univariate and multivariate analyses revealed N stage (favoring N0-N1, p = 0.02, hazard ratio HR 4.2) and World Health Organization histologic type (favoring type III, p = 0.002, HR 13) as significant factors for freedom from distant metastasis. World Health Organization histologic type (p = 0.004, HR 10.5) and age (p = 0.01, HR 1.07/y) were significant factors for survival. Late toxicity included transient cranial nerve weakness in 4, radiation-related retinopathy in 1, and asymptomatic temporal lobe necrosis in 3 patients who originally had intracranial tumor extension. CONCLUSION: STR boost after EBRT provided excellent local control in nasopharyngeal carcinoma patients. The incidence of late toxicity was acceptable. More effective systemic treatment is needed to achieve improved survival.

Adolescent↗

PubMed2003

Comparison of the comet assay and the oxygen microelectrode for measuring tumor oxygenation in head-and-neck cancer patients.

PURPOSE: To compare the Eppendorf PO2 histograph and the alkaline comet assay as methods of measuring tumor hypoxia in patients with head-and-neck squamous cell carcinomas. MATERIALS AND METHODS: As part of a larger clinical trial, 65 patients with head-and-neck squamous cell carcinoma nodal metastasis underwent tumor oxygenation measurements with Eppendorf PO2 histographs and comet assays, performed on fine-needle aspirates at 1 and 2 min after 5 Gy. Fifty-four patients had sufficient tumor cells for comet analysis at 1 min and 26 at both 1 and 2 min. Individual cells were examined for DNA single-strand breaks by alkaline gel electrophoresis, and the distribution of values was quantified using median tail moment (MTM). Nonirradiated tumor cells from pretreatment fine-needle aspirates received 5 Gy in vitro to establish the oxygenated response. RESULTS: There was a significant correlation between the 1- and 2-min MTM (slope = 0.77 +/- 0.03). There was no relationship between DNA damage in tumor cells irradiated in vitro and in vivo. No correlation was found between Eppendorf PO2 measurements and comet MTM. There was a statistically significant correlation between the treatment response in the node studied and comet MTMs, whereas no correlation was observed between treatment response and Eppendorf measurements. CONCLUSIONS: Comet assays are reproducible, as shown by biopsies at 1 and 2 min. Intertumor variation in the MTM is not a result of intrinsic radiosensitivity but of tumor hypoxia. There was no correlation between Eppendorf PO2 measurements and comet MTM. Comet assays were better than Eppendorf in predicting treatment response as an end point for short-term outcome. Longer follow-up is needed to determine the role of the comet assay as a predictor for locoregional tumor control and survivals.

Adult↗

PubMed2003

Endoscopic selective neck dissection in a porcine model.

OBJECTIVE: To investigate the feasibility of accomplishing a selective neck dissection (SND) endoscopically. STUDY DESIGN: Prospective, nonrandomized experimental investigation in a porcine model. METHODS: Unilateral endoscopic SNDs were performed in Yorkshire pigs. A spacious operative pocket was developed using a combination of hernia balloon expansion followed by low-pressure (4 mm Hg) carbon dioxide insufflation. The sternomastoid muscle, thymus, submandibular gland, lymph nodes, and fibrofatty tissue were removed in a procedure approximating a human SND. Data (operative time, blood loss, arterial blood gas values, weight of the specimen, and complications) were prospectively recorded. The specimens were analyzed by a pathologist, and the number and size of lymph nodes were recorded. RESULTS: Fourteen endoscopic SNDs were successfully performed. No conversions to open surgery were necessary. The median operative time was 131 minutes (range, 95-235 minutes). The median estimated blood loss was 4 mL (range, 0-150 mL). The mean +/- SD specimen weight was 42.9 +/- 8.3 g; the mean number +/- SD of nodes retrieved from the neck specimen was 4.8 +/- 2.2, and the mean +/- SD maximal nodal dimension was 2.4 +/- 0.5 cm. The arterial PCO2 increased by an average of only 3.9 mm Hg from the beginning to the end of the surgery; correspondingly, the pH fell by only 0.02. There were no major complications, and no animals had to be euthanized prior to the completion of the procedure. CONCLUSIONS: Endoscopic neck dissection in a porcine model can be accomplished with a combination of strategies to overcome the dilemma of creating and maintaining an operative pocket. The merger of SND with endoscopic technology offers the promise of truly minimally invasive surgery for the node-negative neck.

Anesthesia↗

PubMed2003

Evidence-based medicine in sleep apnea surgery.

Since the first description of sleep apnea as a clinical entity, the understanding of it within the medical community has increased significantly. Much research has explored the causes, assessment, and treatment of this disease. This research has resulted in a variety of tools for assessment and approaches to treatment. As research progresses, new data have shed light on the strengths of traditional approaches and their limitations. This article gives background for current approaches and charts a potential future course for sleep apnea assessment and treatment.

Algorithms↗

PubMed2003

Preliminary findings from a prospective, randomized trial of two tongue-base surgeries for sleep-disordered breathing.

OBJECTIVES: This study compares the efficacy of 2 tongue-base surgical procedures in the treatment of patients with moderate to severe sleep-disordered breathing. STUDY DESIGN AND SETTING: We conducted a prospective, randomized crossover surgical trial at a university hospital. METHODS: Seventeen patients with moderate to severe sleep-disordered breathing and Fujita type II upper airway collapse for whom conservative treatment failed were enrolled into an institutional review board-approved surgical protocol. They were randomly assigned to undergo palatopharyngoplasty combined with either tongue advancement (mandibular osteotomy) or tongue suspension. Parameters assessed included severity of sleep-disordered breathing (polysomnography), sleepiness (Epworth Sleepiness Scale), and anatomic changes (upper airway endoscopy), as well as demographic factors. Patients not achieving satisfactory improvement in their condition were offered nonsurgical management or additional surgical treatment that varied based on the postoperative assessment but included crossing over to the other tongue surgical procedure. RESULTS: Nine of the 17 patients were randomized to the tongue suspension group, and 8 to the tongue advancement group. In the 9 tongue suspension patients, Epworth Sleepiness Scale scores fell from 12.1 to 4.1 (P = 0.007). Airway collapse for all 9 patients measured on Müller maneuver improved, by a mean of 64% (P = 0.0006) at the palate and 83% (P = 0.0003) at the base of the tongue. In the 8 tongue advancement patients, Epworth Sleepiness Scale scores fell from a mean of 13.3 to 5.4 (P = 0.004). Airway collapse for 5 of 8 patients measured on Müller maneuver improved by a mean of 31% (P = 0.1) at the palate and 75% (P = 0.03) at the base of the tongue. CONCLUSION: Prospective, randomized trials of tongue-base surgery for sleep-disordered breathing are possible. Preliminary findings from the current protocol reveal a slight advantage of tongue suspension over tongue advancement.

Adolescent↗

PubMed2003

Airway management after maxillectomy: routine tracheostomy is unnecessary.

OBJECTIVES/HYPOTHESIS: There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management. STUDY DESIGN: Retrospective analysis at a university hospital. METHODS: We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty-four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split-thickness skin graft being the most common reconstructive option. RESULTS: Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year-old man with oxygen-dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise. CONCLUSIONS: The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists.

Adult↗

PubMed2003

Surgical robotic applications in otolaryngology.

OBJECTIVES: To explore the feasibility of performing endo-robotic neck surgery in a porcine model and to compare the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique. STUDY DESIGN: Prospective, nonrandomized experimental investigation in a porcine model. METHODS: We performed a consecutive series of endoscopic neck surgeries using the daVinci surgical system (Intuitive Surgical Inc.). The length of time required to establish the operative pocket and to assemble the robotic components, as well as the total duration of each operation, was recorded. The animals were continuously monitored for heart rate, blood pressure, and end-tidal CO(2) pressure, and evaluation for presence of pneumothorax and subcutaneous emphysema was undertaken postoperatively. The specimens were examined histologically. RESULTS: Four different types of neck surgery were successfully performed on both sides of the neck of four animals using the daVinci surgical system. Creation of the operative pocket took, on average (+/-SD), 18.1 +/- 11.9 minutes, and assembly of the robot required 12.5 +/- 9.9 minutes, resulting in a mean preparation time for all procedures of 30.6 +/- 21.0 minutes. The mean operative time for submandibular resection (n = 3) was 19.0 +/- 6.6 minutes, with a total procedure time of 39.0 +/- 10.2 minutes. Selective neck dissections (n = 3) required a mean operative time of 66.0 +/- 18.5 minutes and a total procedure time of 85.7 +/- 16.7 minutes. One partial parotidectomy and one thymectomy were also performed. The median estimated blood loss was 0 mL (range, 0-10 mL). The end-tidal CO(2) pressure fell from the start to the end of the procedures by a mean of 4.4 +/- 7.9 mm Hg. The blood pressure fell by a mean of 1.9 +/- 7.5 mm Hg. There was one case of modest subcutaneous emphysema, and there were no cases of pneumothorax or air embolism. No conversions to open resection were necessary. CONCLUSIONS: Robotically enhanced endoscopic surgery in the neck is feasible and offers a number of compelling advantages over conventional endoscopic neck surgery. Clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice.

Animals↗

PubMed2003

'Push' versus 'pull' percutaneous endoscopic gastrostomy tube placement in patients with advanced head and neck cancer.

OBJECTIVES/HYPOTHESIS: Percutaneous endoscopic gastrostomy tube (PEG) placement by means of the "pull" method has been reported to result in a significantly higher complication rate when compared with "push" PEG placement. These findings have led to a renewed interest in the push, or Russell introducer, method of PEG placement at the authors' institution when PEG is required before definitive treatment of advanced head and neck cancer. The authors sought to determine whether the push method of PEG placement is associated with a lower incidence of complications in this patient population. STUDY DESIGN: Nonrandomized, retrospective patient analysis. METHODS: The medical records of all patients presenting to the Medical College of Georgia (Augusta, GA) who received a diagnosis of squamous cell carcinoma of the head and neck between 1999 to 2001 were retrospectively reviewed. Patients who required PEG placement as part of their treatment comprised the study population. RESULTS: The push PEG technique was used in 29 patients, and the pull technique was used in 50 patients. There was a statistically significant difference in the complication rate between the two techniques. Patients who underwent placement by means of the pull technique had an overall complication rate of 30% (15 of 50) versus a 0% (0 of 29) complication rate in patients undergoing the push technique (P =.0006, Fisher's Exact test). CONCLUSION: The push PEG technique appears to have a significantly lower risk of complications compared with the pull technique in patients with advanced head and neck cancer. The authors recommend considering the use of the push method when PEG placement is required.

Adult↗

PubMed2003

Minimally invasive orbital decompression for Graves' ophthalmopathy.

We reviewed a 7-year experience at a tertiary-care, academic medical center with balanced, minimally invasive decompression for Graves' ophthalmopathy, in an effort to define the goals, risks, and outcomes of surgical intervention. Endoscopic medial decompression was performed in 26 patients; 23 underwent lateral decompression as well, and 13 also had inferior decompression. Septoplasty, turbinate reduction, and orbital rim augmentation were performed as needed. The indications for surgery were threat to vision (n = 10) and proptosis with a desire to return to the predisease state (rehabilitative, n = 16). The exophthalmos improved by a mean of 4.4 mm (p < .001). All patients who had surgery for threatened vision had improved vision after the operation. There were 3 patients with new-onset postoperative diplopia, 2 of whom underwent strabismus surgery. There was 1 case of postoperative sinusitis, which resolved with oral antibiotics and nasal decongestion, and 1 case of transient ulnar neuropathy. There were no other intraoperative or postoperative complications. Modern methods of orbital decompression provide a minimally invasive, effective, and relatively safe approach to the treatment of Graves' ophthalmopathy.

Adult↗

PubMed2003

Identification of osteopontin as a prognostic plasma marker for head and neck squamous cell carcinomas.

PURPOSE: Tumor hypoxia modifies treatment efficacy and promotes tumor progression. Here, we investigated the relationship between osteopontin (OPN), tumor pO(2), and prognosis in patients with head and neck squamous cell carcinomas (HNSCC). EXPERIMENTAL DESIGN: We performed linear discriminant analysis, a machine learning algorithm, on the NCI-60 cancer cell line microarray expression database to identify a gene profile that best distinguish cell lines with high Von-Hippel Lindau (VHL) gene expression, an important regulator of hypoxia-related genes, from those with low expression. Plasma OPN levels in 15 volunteers, 31 VHL patients, and 54 HNSCC patients were quantitatively measured by ELISA. The relationships between plasma OPN levels, tumor pO(2) as measured by the Eppendorf microelectrode, freedom from relapse (FFR), and survival in HNSCC patients were evaluated. RESULTS: Microarray analysis indicated that OPN gene expression inversely correlated with that of VHL. These findings were confirmed by Northern blot analysis. ELISA studies and Western blot in a HNSCC cell line demonstrated that hypoxia exposure resulted in increased OPN secretion. Patients with VHL syndrome had significantly higher plasma OPN levels than healthy volunteers. Plasma OPN level inversely correlated with tumor pO(2) (P = 0.003, r = -0.42). OPN levels correlated with clinical outcomes. The 1-year FFR and survival rates were 80 and 100%, respectively, for patients with OPN levels 450 ng/ml (P = 0.002 and 0.0005). Multivariate analysis revealed that OPN was an independent predictor for FFR and survival. CONCLUSIONS: Plasma OPN levels appeared to correlate with tumor hypoxia in HNSCC patients and may serve as noninvasive tests to identify patients at high risk for tumor recurrence.

Adult↗

PubMed2002

Effect of blood transfusion in an experimental sarcoma model.

OBJECTIVE: To study the effect of allogeneic, syngeneic, and autologous blood transfusion on the growth rate of the KHT tumor in a C3H murine model. DESIGN: Prospective, randomized, and controlled animal study. SUBJECTS: Sixty-one C3H female mice. INTERVENTIONS: The C3H female mice were implanted with 2 x 10(5) cells of KHT, a murine sarcoma. Ten days later, 0.3 mL of blood was removed from a retro-orbital site to simulate surgical blood loss. This blood loss was replaced by blood transfusion through a tail vein with the use of allogeneic (major histocompatibility complex incompatible), syngeneic (major histocompatibility complex compatible), or autologous blood. Tumor growth was measured daily for 14 days. The tumor growth curve for each of the animals was constructed and the mean slope of growth calculated for each group. RESULTS: There were statistically significant differences in tumor growth rate (P =.001) when the allogeneic group (mean slope = 0.232, n = 14), the syngeneic group (mean slope = 0.190, n = 17), and the autologous group (mean slope = 0.202, n = 14) were compared. A t test confirmed that there was no significant difference in the tumor growth rate between the groups transfused with syngeneic and autologous blood (P =.26). However, the rate of tumor growth in the allogeneic group was found to be significantly higher when independently compared with the syngeneic group (P<.001) and the autologous group (P =.02). CONCLUSIONS: In this experimental model of a solid murine sarcoma, allogeneic blood transfusion was associated with an increased rate of tumor growth compared with syngeneic and autologous blood transfusion, likely reflecting immunomodulatory effects incurred by the introduction of major histocompatibility complex-incompatible antigens.

Animals↗