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Biomedical subjects

F Paulsen

Publications and source records attributed to F Paulsen.

52 records · Page 3Linked to original sources
PubMed1998

Epithelial-connective tissue boundary in the oral part of the human soft palate.

The papillary layer of the oral part of the human soft palate was studied in 31 subjects of different age by means of histological, immunohistochemical and scanning electron microscopical methods. For scanning electron microscopy a new maceration method was introduced. Results determine epithelial thickness, height and density of connective tissue papillae and their 3-dimensional architecture inside the lining epithelium as well as the collagenous arrangement of the openings of the glandular ducts. The individual connective tissue papillae of the soft palate are compared with the connective tissue boundary on the other side of the oral cavity. The connective tissue plateaux carrying a variable number of connective tissue papillae were found to be the basic structural units of the papillary body. The function of the epithelial-connective tissue interface and the extracellular matrix arrangement in the lamina propria are discussed in order to promote the comparability of normal with pathologically altered human soft palates.

Aged↗
PubMed1998

Radiation-induced gastrointestinal toxicity. Pathophysiology, approaches to treatment and prophylaxis.

BACKGROUND: Gastrointestinal toxicity is frequently observed during radiotherapy of malignancies in the abdomen and pelvis. The proposed pathophysiology of radiation enteritis is complex and a variety of different treatment strategies have been suggested for the management of acute radiation-induced diarrhea. MATERIAL AND METHODS: Data are presented from an extensive review of the current literature. RESULTS: Radiation-induced diarrhea results from a variety of different pathophysiological mechanisms including malabsorption of bile salts and lactose, imbalances in local bacterial flora and changes in the intestinal patterns of motility. Up to date acute radiation diarrhea is predominantly treated symptomatically using opioide derivates (loperamide) or adsorbants of bile salts such as smectite. Clinical trials have been performed using L. acidophilus, smectite or sucralfate for diarrhea prophylaxis with moderate reduction of acute symptoms. CONCLUSIONS: Further evaluation of strategies for diarrhea prophylaxis is warranted. Due to the complex nature of radiation enteritis a multimodal approach taking into account alterations in intestinal motility patterns, malabsorption of bile salts and an imbalance of mucosal bacterial flora may offer new perspectives.

Abdominal Neoplasms↗
PubMed1997

Functional and clinical anatomy of the posterior insertion of the human vocal ligament.

The suggested methods of the formation of intubation granuloma as well as carcinoma invasion in the area of posterior vocal ligament insertion have been controversial. One reason for divergent opinions is possibly based on different judgements of morphology in this region. The present study analyzed structures of the vocal ligament and vocalis muscle insertion at the vocal process by means of histological, immunohistochemical and electron microscopic methods. Investigations were performed in three planes on the vocal cords of 22 men and 19 women (aged 21-97 years). Inside the insertion zone of the vocal ligament at the vocal process three structures could be distinguished: hyaline cartilage at the base of arytenoid cartilage, elastic cartilage at its apex and the posterior elastic nodule in front of them. No perichondrium could be seen around the elastic nodule. In elastic nodules type I and type III collagen fibrils as well as elastic fibers formed a scissor-like meshwork around large fibroblasts. The vocalis muscle inserted at the perichondrium in the lateral part of the arytenoid skeleton by short tendons. At the insertion zone blood vessels of the vocalis muscle penetrated the perichondrium and reached the cartilaginous matrix. At the beginning of osteogenesis, the blood vessels connected with intraosseous blood vessels of the arytenoid. Connective tissue cells of the insertion zone and extracellular matrix components formed by these cells fulfilled a biomechanical function by equalizing the different elastic moduli of tendon, cartilage or bone. The lack of perichondrium around the lengthened posterior elastic nodule made formation of intubation granulomas caused by perichondritis in this area impossible. Loosened perichondrium or periosteum in the area of the insertion of the vocalis muscle at the vocal process, ossification and associated vascularization of the arytenoid skeleton permitted invasion of carcinomas into the arytenoid.

Adult↗
PubMed1997

[The use of sucralfate in radiation oncology].

PURPOSE: Radiotherapy, a cornerstone in the management of head and neck cancer, pelvic cancer, and esophageal cancer is associated with a marked mucosal toxicity. Pain, malnutrition and diarrhea are the most prevalent clinical symptoms of radiation induced mucosal damage. Because there is no known way to obviate radiation mucositis all efforts to prevent aggravation and accelerate healing of mucosal changes are of great importance. Numerous agents including antimicrobials, local and systemic analgesics, antiinflammatory drugs, antidiarrheal drugs, in combination with intensive dietetic care are used to relieve symptoms. Recently coating agents like the polyaluminum-sucrose complex sucralfate were suggested for the prevention and treatment of mucosal reactions. Since sucralfate protects ulcerated epithelium by coating, liberates protective prostaglandins and increases the local availability of protective factors this drug might directly interact with the pathogenesis of mucositis. PATIENTS AND METHOD: The results of available studies are analysed and discussed. RESULTS: The results of several studies indicate that sucralfate treatment especially during radiotherapy for pelvic cancer leads to a significant amelioration of clinical symptoms and morphological changes. An application of sucralfate during radiotherapy of head and neck cancer reveals only limited benefits in most studies performed. CONCLUSION: Nevertheless sucralfate is a safe, cheap and active drug for the prevention and treatment of radiation mucositis especially in patients with pelvic irradiation.

Head and Neck Neoplasms↗
PubMed1996

[Structure and function of the ventral vocal cord insertion. From the clinical viewpoint].

BACKGROUND: Spread of cancer at the ventral vocal fold insertion zone has been discussed controversially until today. One reason for this is the so far insufficient knowledge of the anatomical structure and function of the insertion zone. METHODS: The present study analyses the structures of laryngeal anterior commissure by means of histological, immunohistochemical and electron microscopical methods. Investigations are performed on vocal cords of 17 male and 13 female (aged 21-88 years) in three planes. RESULTS: The vocal ligament inserts at the anterior commissure via two characteristic structures: the noduli elastici, which consist of two different morphological zones, and the vocal ligament tendon, a dense mesh of connective tissue rich in sulfated glycosaminoglycans. In the lower part of noduli elastici collagen and elastic fibres form a meshwork around embedded cells; in the upper part fibres are running in parallel. The vocal ligament tendon is connected to the thyroidal cartilage or bone by fibrocartilage. This area lacks a perichondrium or periosteum. At the beginning of osteogenesis vessels of plica vocals penetrate the bony thyroidal skeleton and contact with extralaryngeal vessels. CONCLUSIONS: Connective tissue cells of the insertion zone and extracellular matrix components formed by these cells fulfil biomechanical functions by equalizing the different elastic moduli of tendon, cartilage or bone. Ventral spread of vocal fold carcinomas is made possible by the lack of periosteum in the insertion zone as well as ossification and associated vascularisation of the thyroid cartilage.

Adult↗
PubMed1996

[Acute gastrointestinal side effects of radiotherapy. What is certain in the treatment?].

PURPOSE: Radiotherapy, especially in the abdominal region, is frequently associated with gastrointestinal side effects. METHODS: The article reviews the current knowledge about pathophysiological background, clinical symptoms and the treatment strategies of the major gastrointestinal side effects. RESULTS: Several basics are investigated and depending on this knowledge some special treatment strategies have been developed (5-HT3-receptor-antagonists in the treatment of nausea, Figure 1, Table 2). The treatment of stomatitis, esophagitis, enteritis and proctitis still remains symptomatic and is not yet standardized (Tables 3 to 6). There are some promising results with smectit (enteritis) and sucralfat. Special dental attendance should be performed before initiating radiotherapy of the head and neck region. Technical improvement in radiotherapy will also help to reduce side effects. CONCLUSION: In order to minimize gastrointestinal side effects, it is necessary to further investigate the pathophysiology of acute and late toxicity.

Abdominal Neoplasms↗
PubMed1994

[Structures of the anterior commissure of the larynx. Biomechanical and clinical aspects].

The vocal ligaments and vocalis muscles insert at the anterior commissure of the thyroid cartilage. The biomechanical function of the connective tissue of the insertion is to equalise the different elastic modules of tendons and cartilage or bone. Structures of the insertion of plica vocalis at the anterior commissure are clinically important considering the spread of carcinoma that can grow along the vocal ligament in a ventral direction. The lack of perichondrium or periosteum in the area of insertion, ossification of the thyroid cartilage and the associated vascularisation of the skeleton allow the invasion of tumours in the thyroidal skeleton.

Adolescent↗
PubMedDate not supplied

Evaluation of polyurethane nasolacrimal duct stents: in vivo studies in New Zealand rabbits.

The purpose of this study was to evaluate the radiographic and biological effects of different polyurethane nasolacrimal duct stents in an animal model. Fifteen polyurethane nasolacrimal duct stents (n = 5 mushroom-type stents, n = 5 newly designed S-shaped TearLeader stents without hydrophilic coating, and n = 5 S-shaped TearLeader stents with hydrophilic coating) were implanted in the nasolacrimal ducts of eight unaffected New Zealand rabbits. One nasolacrimal system served as control. Clinical and radiographic follow-up was performed at 1-, 2-, and 4-week intervals, then after a 3-month interval, after which the animals were euthanized. All stents were implanted without major periprocedural complications. The stents proved to be patent by the end of the procedure. During follow-up, all mushroom-type stents were occluded at 4 weeks. None of these stents opened to forced irrigation. Clinically, all rabbits demonstrated severe dacryocystitis. Three out of five TearLeader stents without hydrophilic coating were blocked at 4 weeks; one out of five was open to irrigation. Best results were observed in the stent group with hydrophilic coating. Follow-up dacryocystography demonstrated patent stents in nasolacrimal ducts of all animals after 4 weeks. In only one of five cases, the coated stent became partially occluded after 2 months. These animals were free of clinical symptoms. After 3 months, at least three out of five stents still opened to forced irrigation and only one stent was completely blocked. Dislocation of the stents was not observed. Refinement of the stent surface and stent design improves the results of nasolacrimal duct stenting in this animal model. Implantation of hydrophilic-coated S-shaped stents is highly superior to conventional mushroom-type stents and noncoated stent types. Hydrophilic coating seems to prevent foreign-body reactions, resulting in maximized stent patency.

Animals↗
PubMedDate not supplied

Cystosarcoma phyllodes malignum: a case report of a successive triple modality treatment.

This paper reports on a woman with a rapidly growing recurrent cystosarcoma phyllodes malignum after two major attempts of surgery. In this situation, neoadjuvant hyperfractionated radiotherapy, superficial hyperthermia and ifosfamide were administered. Toxicity was mild. Resection of the tumour bed revealed a pathologically complete response with an actual disease free follow-up of 48 months.

Antineoplastic Agents, Alkylating↗
PubMedDate not supplied

Thermoradiotherapy for locally recurrent breast cancer with skin involvement.

PURPOSE: This retrospective analysis investigated the effectiveness and side-effects of combined hyperthermia and radiation therapy in locally recurrent breast cancer after primary modified radical mastectomy. The aim of the thermoradiotherapy was to reduce the substantial risk of symptomatic chest wall disease. MATERIALS AND METHODS: Between May 1995-August 1998, 39 extensively pre-treated women with progressive locoregional chest wall tumours were treated with local radiofrequency hyperthermia, given twice a week immediately before radiotherapy. Sixty-two per cent of the patients had received previous radiotherapy, with a median dose of 50 Gy, 64% had received chemotherapy, 36% hormonal therapy, and 13% local therapy with miltefosin, respectively. Nine patients were treated for microscopic residual disease after local tumour excision (R1-resection) and 30 patients for gross macroscopic nodular recurrences. Twenty-seven patients had two adjacent hyperthermia fields at the ipsilateral chest wall to cover the whole irradiation area. Each field received a median of seven local hyperthermia sessions (range 2-12, average 5.6 sessions) just before radiation therapy, with a median dose of 60 Gy (range 30-68 Gy). The monitored maximum(average) and average(average) epicutaneous temperatures were 42.1 degrees C and 41.0 degrees C, respectively. Maximum(average) and average(average) intratumoural temperatures of 43.0 degrees C and 41.1 degrees C, respectively, were achieved in nine chest wall recurrences with intratumoural temperature probes. Concurrent hormonal therapy was administered in 48%, and concurrent chemotherapy in 10% of patients. RESULTS: Median overall survival time was 28 months (Kaplan Meier), with 71% and 54% of patients living 1 and 2 years after thermoradiotherapy. The median time to local failure has not been reached, local tumour control after 2 years being 53%. Actuarial 1 and 2 year local tumour controls for microscopic residual disease were 89%, and for macroscopic nodular recurrences 71% and 46%, respectively (p = 0.09). Actuarial 1 and 2 year local tumour controls after treatment with a total dose of less than 60 Gy were 51% and 38%, respectively, and, after a total dose greater than 60 Gy, 84% and 60% (p = 0.01), respectively. Actuarial 1 year local tumour control was 92% after complete tumour remission, versus 57% after partial remission (p = 0.002). Three of the 39 patients died of cancer en cuirasse, 13 patients due to distant metastases. Acute thermoradiotherapy related erythema, dry desquamation and moist desquamation were seen in 28.2%, 30.7%, and 30.7% of patients, respectively. Soft tissue necrosis occurred in two patients with previous post-operative delayed wound healing, and in one patient above a silicon implant. CONCLUSION: This study showed that, in extensively pre-treated patients with locally recurrent breast cancer, local tumour control after thermoradiotherapy depended on tumour resectability, response of macroscopic tumour to thermoradiotherapy, and total irradiation dose.

Adult↗
PubMedDate not supplied

Appendicitis during locoregional thermoradiotherapy of advanced or recurrent rectal and cervical cancer, a report of two cases.

INTRODUCTION: Local tumour control after irradiation alone for advanced, inoperable carcinomas of the bladder and rectum or inoperable recurrent cervical carcinoma is usually disappointing. Both preclinical and clinical studies reported improvements by adding hyperthermia to radiotherapy. Reports for phase II/III trials do not indicate any enhanced side effects. However, two cases of acute suppurating appendicitis were observed in a series of patients treated with deep regional hyperthermia. MATERIALS, METHODS AND RESULTS: Eighty patients with advanced, inoperable, or recurrent rectal or recurrent cervical tumours were treated with deep regional hyperthermia (313 sessions) in addition to radiotherapy between September 1995 and October 1998. The treatment for two of these patients (2.5%) had to be discontinued after the fourth/second hyperthermia treatments at 19.8/10.8 Gy total dose, respectively, for symptoms of pain in the right pelvis and elevated rectal temperature. Both patients underwent laparotomy and were found to have suppurative appendicitis. In addition to the retrocoecal location in both patients, evidence of preexisting chronic appendicitis, and appendiceal faecalith were observed in each patient. CONCLUSION: The development of acute appendicitis in 2.5% of patients during a course of deep regional thermoradiotherapy for pelvic tumour is much higher than the expected incidence of appendicitis in the general population (< 1/1000) (Korner et al. 1997). An enhanced risk of suppurative appendicitis in patients undergoing pelvic thermoradiotherapy cannot be excluded, especially in retrocoecal located appendices with obstructed appendix lumen from preexisting chronic appendicitis or faecalith.

Appendicitis↗
PubMedDate not supplied

Leukocyte rheology in recent stroke.

Eighteen patients with recent ischemic stroke were compared with an equal number of matched controls. Standardized suspensions of red cells as well as of red and white cells were filtered in a new filtration apparatus capable of discriminating between cell deformability and filter occlusion. Results show that red cell deformability, although slightly lower than in controls, is not significantly altered in stroke patients. Filter occlusion, however, was significantly higher in patients when red and white cell suspensions were filtered, but not when red cell suspensions were used, suggesting that white cell filterability is impaired after stroke, which could be due to decreased deformability and/or increased adhesiveness of leukocytes. Slowed white cell passage may also occur in the living microcirculation and may present an obstacle to nutritive flow in exchange vessels, possibly contributing to local ischemia and tissue necrosis after stroke.

Aged↗
PubMedDate not supplied

The triple classification of dry eye for practical clinical use.

PURPOSE: "Dry Eye is a condition produced by the inadequate interrelation between lacrimal film and ocular surface epithelium, and is caused by quantitative and qualitative deficits in one or both of them. It can be produced by one or combined etiologic causes, affecting one or several of the secretions of the glands serving the ocular surface, and producing secondary manifestations of different grades of severity". Clinicians need a practical classification to face diagnosis, prognosis and treatment. Dry eyes have many etiologies and pathogenesis, different affectation of the various dacryoglands and ocular surface epithelium, and diverse grades of severity. The specialists in xero-dacryology must know these three parameters to evaluate any case of dry eye, and to establish an adequate treatment. METHODS: To facilitate this, an open session in the 8th congress of the International Society of Dacryology and Dry Eye (Madrid, April, 2005) proposed modifying the Triple Classification of dry eye approved in the XIV congress of the European Society of Ophthalmology (Madrid, June, 2003). There was consensus of all conclusions. CONCLUSIONS: The following classification has been established: First, a classification of the etio-pathogenesis, distributed in ten groups: age-related, hormonal, pharmacologic, immunopathic, hyponutritional, dysgenic, infectious/inflammatory, traumatic, neurologic and tantalic. Second, a classification of the affected glands and tissues, which under the acronym of ALMEN includes the Aqueo-serousdeficient, Lipodeficient, Mucindeficient and Epitheliopatic dry eyes, and the Non dacryological affected exocrine glands (saliva, nasal secretion, tracheo-pharyngeal secretion, etc). And thirdly, a classification of severity, in three grades: Grade 1 or mild (symptoms without slitlamp signs), grade 2 or moderate (symptoms with reversible signs), and grade 3 or severe (symptoms with permanent signs).

Aging↗
PubMedDate not supplied

[Blood and hair arsenic, lead and cadmium analysis of adults and correlation analysis with special reference to eating habits and other behavioral influences].

In the present work the background burden of arsenic (As), lead (Pb) and cadmium (Cd) was determined in blood (B) and hair (H) samples of male and female adults. The results were combined with personal data like food consumption habits and other confounding factors, and were evaluated by correlation analyses. As, Pb, and Cd determination was performed by atomic absorption spectrometry (AAS), using graphite-furnace AAS for the determination of Pb and Cd, and fluid injection AAS for the determination of As, respectively. All persons participating in this study were not unusually exposed to these elements, neither in their working places nor at home. As, Pb and Cd concentration in the B- and H-samples were in a very low range corresponding to similar data presented in the literature. Although the number of samples was too small for definite conclusions, the following significant correlations between the element concentration in B- and H-samples as well as between the other confounding factors should be considered: H-As depends on B-As; H-Pb depends on B-Pb; H-Pb corresponds to H-Cd; H-Cd, H-Pb distal > proximal; H-As distal < proximal; B-Cd, B-As, H-Pb in smokers > non smokers; H-As, B-Pb, H-Pb males > females; B-Pb positively correlated to wine drinking: B-Pb negatively correlated to daily consumption of mineral water; B-Pb positively correlated to daily consumption of vegetables; B-As positively correlated to fish consumption; B-Pb, H-Pb increase with increasing age of houses. Due to the low concentration of As, Pb and Cd found in the B- and H-samples contamination must be regarded as high risk. The application of AAS for the metal determination in blood is generally accepted and has become a routine method for this purpose. The possibilities of contamination are well known and can be avoided. However, the element determination in hair samples by AAS bares a great risk of falsification by contamination, especially, when the determination is performed only in one or two hair samples of normally exposed individuals with very low element concentrations. On the other hand, when element determination is performed in sufficiently large numbers of hair samples (with the chance to neglect occasionally extreme values). AAS may be applied for element analysis in hair samples, too. It may be a vulnerable analytical method in research programmes of epidemiology and environmental toxicology.

Adolescent↗