Biomedical subjects

H Iro

Publications and source records attributed to H Iro.

At least 127 records · Page 7Linked to original sources

PubMed1994

[Localized amyloidosis in the area of the head-neck. A retrospective study].

Localized amyloidosis is a benign rare process in the head and neck. From 1972 to 1992, 12 patients with amyloid deposits of the head and neck were treated at the ENT Department of the University of Erlangen-Nürnberg. Negative congo red staining of rectal biopsy specimens established that the amyloidosis was not systemic. Localized amyloidosis appeared as a diffuse grey-to-yellow mass in the nose (n = 1) or larynx (n = 11). In 10 of the 12 cases excision of amyloid was possible with preservation of adjacent functional structures. Two patients refused surgery and underwent only symptomatic treatment with clinical followup investigations. Amyloid deposits completely excised did not recur during a mean postoperative period of 10 years. When not operated, the amyloid tumors showed a slowly progressive growth pattern.

Adolescent↗

PubMed1994

Prognostic value of S-phase fraction in head and neck squamous cell carcinomas and nodal negative breast carcinomas.

PURPOSE: The prognostic value of proliferative activity (percentage of S-phase cells = SPF) was determined in head and neck and nodal negative breast carcinomas and correlated with treatment outcome and analysis of recurrence. METHODS AND MATERIAL: SPF of 171 primary squamous cell carcinomas of the head and neck and 183 nodal negative breast carcinomas was determined by one-dimensional flow cytometry. RESULTS: For the whole population of head and neck carcinomas slowly proliferating tumors (SPF < median) had a better five-year survival rate (28%) than fast proliferating tumors (S-phase > median; 20% p < 0.05). Failure analysis revealed that the better survival of slowly proliferating tumors was due to the higher loco-regional control rate (62%) compared to fast proliferating tumors (43%; p < 0.05). Stepwise multivariate analysis revealed treatment modality (p = 0.107), SPF (p = 0.026) and UICC stage (p = 0.044) as independent prognostic factors for loco-regional recurrences and SPF (p = 0.0143) for three-year overall survival. In nodal negative breast cancer slowly proliferating tumors (SPF < median) had a better NED survival (92%) compared to fast proliferating tumors (SPF > median; NED survival 63%). The analysis of recurrence revealed a higher rate of distant metastases (15.7%) and of loco-regional recurrences (21%) for fast proliferating tumors as compared to slowly proliferating tumors (distant metastases: 1.1%; loco-regional recurrences 4.5%). Stepwise multivariate analysis showed that SPF (p = 0.001) was the only independent prognostic factor for NED survival; grading (p = 0.022), age (p = 0.003) and SPF (p = 0.007) for freedom from distant metastases; SPF (p = 0.0039), grading (p = 0.0956) and method of surgical treatment (p = 0.0715) for loco-regional recurrences. CONCLUSIONS: SPF has a relevant prognostic power for squamous cell head and neck cancer and nodal negative breast cancer.

Adult↗

PubMed1993

Minimally invasive surgery in otorhinolaryngology.

Otorhinolaryngology has always strived to improve the diagnostic and therapeutic possibilities of managing afflicted organs by developing technically and conceptually new and advanced treatment techniques. The endeavor to develop methods with minimized patient discomfort during interventional surgery in the head and neck region was an essential motive which gave rise to the discipline of ENT medicine. Since fairly recently, the term "minimally invasive surgery" has become firmly established in the domain of general surgery. The possibility for replacing a substantial number of routine operations by endoscopic procedures with low levels of discomfort for the patient and shorter periods of hospitalization has given the term "minimally invasive" even further wide-ranging significance. The present review endeavors to provide an assessment of the current state-of-the-art in otorhinolaryngology, giving special attention to the historical development and pathophysiological fundamentals of this field.

Endoscopy↗

PubMed1993

The influence of supportive nutritional therapy via percutaneous endoscopically guided gastrostomy on the quality of life of cancer patients.

Between April 1987 and May 1990 a total of 212 consecutive patients with tumours in the head and neck region were admitted to a prospective study comparing planned prospective enteral nutrition via percutaneous endoscopically guided gastrostomy (PEG; n = 47) and oral nutrition (n = 134). The nutritional status (anthropometric and laboratory chemical parameters) and the quality-of-life index according to Padilla et al. [Res Nurs Health 6:117-126 (1983)] were determined prior to radiotherapy, 2, 4, 6 weeks later during radiotherapy and 6, 12 and 18 weeks after completion of radiotherapy. The quality-of-life score of the orally nourished patients decreased quickly during radiotherapy and improved only slowly afterwards. Although PEG patients had a worse starting score, their quality-of-life index did not deteriorate during therapy (statistically significant difference between the two groups). The same applies to the nutritional status. These results show that an early and constant enteral nutrition by PEG can stabilize the nutritional state and the quality of life of patients with tumours of the head and neck area during radiotherapy.

Adult↗

PubMed1993

[Minimally invasive treatment of sialolithiasis using extracorporeal shock waves].

BACKGROUND: In the past, management of sialolithiasis required surgical extirpation of the afflicted gland, in case the concrements could not be removed by dilatation or dissection of the glandular duct. The aim of the present study was to investigate the safety and efficiency of extracorporeal shockwave lithotripsy of salivary gland stones in men. PATIENTS AND METHODS: 51 patients with symptomatic solitary salivary stones which could not be removed by conservative measures received extracorporeal piezoelectric shockwave treatment. The concrements had a median diameter of 8 (4-18) mm and were located in the submandibular gland (69%) and in the parotid gland (31%). A total number of 72 shockwave treatments (maximum 3 treatments per patient) were performed under continuous sonographic monitoring. RESULTS: In 45 patients (88%) complete fragmentation of the concrements was achieved. Piezoelectric shockwave therapy was tolerated without any need for anesthesia, nor administration of sedatives or analgesics. The only untoward effects resulting from therapy were individual localized petechial hemorrhages after 10 out of 72 treatments (13%) and transient swelling of the gland immediately after shockwave application (2/72, (3%)). Twenty weeks after initial treatment 90% of the patients (46/51) were free of discomfort, and 53% of the patients (27/51) were stone free. The stone clearance rates of patients exhibiting concrements of the parotid gland (81%) were significantly higher than those of patients with stones of the submandibular gland (40%, p < 0.01). Auxiliary measures such as dilatation or dissection of the salivary duct were required only in patients suffering from concrements of the submandibular gland (20%). No long-term damage to the treated salivary gland nor to adjacent tissue structures were noted during the median follow-up period of 9 (1-24) months. CONCLUSION: Extracorporeal piezoelectric shockwave therapy promises to become a safe, comfortable and effective minimal-invasive, non-surgical treatment of salivary stones.

Adolescent↗

PubMed1993

[Electrohydraulic intracorporeal lithotripsy of salivary calculi. In vitro and animal experiment studies].

BACKGROUND: Extracorporeal lithotripsy is now used routinely for the treatment of salivary duct stones. The question arose whether electrohydraulic intracorporeal lithotripsy, which is applied in urology and gastroenterology, might also be useful in the treatment of this disease. Before its possible clinical application the influence of electrohydraulic intracorporeal shock waves on salivary stones in vitro and any influence on the tissue in the head and neck region (in vivo) had to be investigated. MATERIALS AND METHODS: In vitro experiments. Fifty-eight salivary stones and 11 extirpated human submandibular glands were treated by three different electrohydraulic devices. Animal experiments. Electrohydraulic shock waves were applied to the dilated Stensen's duct and other tissues (muscle, parotid gland, facial nerve) of six rabbits. RESULTS: Of 58 salivary stones, 53 (91%) were fragmented, 39 (67%) with a remaining size of less than 1.5 mm and 14 (24%) more than 1.5 mm. In 5 cases (9%) no effects were seen at all. Fragmentation occurred independent of the mineralogical components of the stone and independent of the different lithotriptors used. The smaller the probe diameter and the larger the stone, the more shock waves were needed to achieve fragmentation. With the smaller probes the stones could not be fragmented completely. In human submandibular glands, extensive tissue lesions could be evidenced macroscopically and histologically after application of electrohydraulic shock waves in vitro. Application of electrohydraulic shock waves to the dilated parotid gland duct of rabbits led to perforations of the duct after 1-5 single pulses. Lesions of nerves and blood vessels could also be observed within the duct environment. This occurred with all of the different electrohydraulic devices, probe diameters and intensities used. In our opinion the damage produced is probably the result of both the direct effect of the plasma as well as the resultant stress wave. CONCLUSION: In view of the severe damage caused to different tissues, use of the described method for the treatment of stones in the narrow human salivary ducts should be greatly restricted.

Animals↗

PubMed1992

Shockwave lithotripsy of salivary duct stones.

Surgical extirpation of the affected gland has been necessary for cases of sialolithiasis in which the stone cannot be removed by dilatation or dissection of the salivary duct. The ability of the piezoelectric lithotripter to deliver shockwaves to a small focus makes extracorporeal shockwave lithotripsy of salivary gland stones potentially safe. Its safety and efficacy have been assessed in 51 patients with symptomatic solitary salivary stones that could not be removed by conservative measures. The stones had a median diameter of 8 (range 4-18) mm and were located in the submandibular gland in 69% of patients and in the parotid gland in 31%. A total of 72 shockwave treatment sessions (maximum 3 per patient) were given under continuous sonographic monitoring. In 45 patients (88%) complete fragmentation (fragments less than or equal to 3 mm) of the concrements was achieved. No patient needed anaesthesia, sedatives, or analgesics. The only untoward effects were localised petechial haemorrhages after 10 (13%) out of 72 treatments and transient swelling of the gland immediately after delivery of shockwave in 2/72 (3%) sessions. 20 weeks after the first session 90% (46/51) of patients were free of discomfort, and 53% (27/51) were stone free. Stone-clearance rate was higher among patients with stones in the parotid gland (81%) than among those with stones of the submandibular gland (40%). Auxiliary measures such as dilatation or dissection of the salivary duct were required only in patients with stones in the submandibular gland (20%). No long-term damage to the treated salivary gland or to adjacent tissue structures was noted during the median follow-up of 9 (1-24) months. Extracorporeal piezoelectric shockwave therapy seems likely to be safe, comfortable, and effective minimally-invasive, non-surgical treatment for salivary stones.

Adolescent↗

PubMed1992

Investigations on health hazards of chimney sweeps in Germany: results of a follow-up study.

Within the framework of a longitudinal study, 127 chimney sweeps from the area of Upper and Middle Franconia (Bavaria, Germany), who had participated in a first medical check-up in 1974, were offered follow-up examinations in 1990. Eighty-one subjects participated in these examinations; in addition individual occupational case histories and medical case histories were obtained for a further 15 and 35 chimney sweeps, respectively. Five test subjects had died before the evaluation deadline (August 15, 1990). The causes of death were a non-Hodgkin's lymphoma, a bladder carcinoma, pulmonary metastases with unknown primary tumour, a suicide and an acute myocardial infarction. Conspicuous results were carcinoma of the oesophagus in one case and leucoplakia of the mucous membranes in the mouth and pharyngeal region in three cases; furthermore one chimney sweep had two haemorrhagic lumps on his vocal cords. Taking into account important non-occupational hazards (alcohol and nicotine abuse) as possible causes of these changes and the lack of relevant occupational exposure to products of incineration over a number of years, none of these cases nor any of the other ascertained results could be considered likely to be causally related to occupational activities. Due to the small number of cases, an epidemiological risk evaluation did not seem useful. Comparison with the results of other chimney sweep studies published in the international literature is not helpful due to the differences in study design, the varying case frequencies, and the different conditions of exposure.

Adult↗

PubMed1992

Interstitial thermal radiation therapy: five-year experience with head and neck tumors.

Sixty-two patients with 24 primary advanced, six persistent, 28 locally recurrent, and four metastatic tumors of the head and neck were treated with combined interstitial low-dose iridium-192 radiation therapy, interstitial 915-MHz microwave hyperthermia (IHT), and external-beam radiation therapy. Diagnoses were squamous cell carcinoma in 56, adenocarcinoma in three, and soft-tissue sarcoma in three lesions. IHT was applied immediately before Ir-192 was placed and after its removal for 45-60 minutes at 41 degrees C-44 degrees C. At 3 months, complete remission had occurred in 39 lesions; partial remission, in 18; and no change or progressive disease, in five. At 12-month follow-up, local control was achieved in 29 of 50 patients; seven other patients had slow ongoing tumor regression with an unclear residual mass at computed tomography or magnetic resonance imaging. Lesion type, tumor volume, total radiation dose, and thermal parameters with "good quality of heating" at high minimum tumor temperature were identified as statistically significant (P less than .05) prognostic factors influencing initial and long-term tumor response. There was no prognostic factor for acute or late thermal damage.

Adolescent↗

PubMed1992

Extracorporeal piezoelectric shock-wave lithotripsy of salivary gland stones.

Piezoelectric lithotripsy was undertaken on 19 patients with salivary stones, with none of these patients requiring anesthesia, analgetics, or sedatives. All salivary stones were totally fragmented during first lithotripsy. Four months after treatment with extracorporeal shock waves, all patients were free of symptoms and, in 11 of the patients, no calculi could be found sonographically. The piezoelectric lithotripsy of salivary stones caused no serious side effects which could be proven by clinical, biochemical, sonographic, and magnetic resonance imaging (MRI) examinations. Extracorporeal piezoelectric lithotripsy is a new and promising nonsurgical therapy for selected cases of sialolithiasis of the parotid and submandibular glands.

Adult↗

PubMed1992

Extracorporeal piezoelectric shock wave lithotripsy of salivary gland stones: first clinical experiences.

Piezoelectric lithotripsy was undertaken on 14 patients with salivary stones, none of them requiring anesthesia, analgesics, or sedatives. All salivary stones were fragmented totally during the first lithotripsy session. Four months after treatment with extracorporeal shock waves all patients were free of symptoms, and in seven out of 14 patients no concrement could be found sonographically. The piezoelectric lithotripsy of salivary stones had caused no serious side effects proved by clinical, biochemical, sonographic, and magnetic resonance imaging examinations. Extracorporeal piezoelectric lithotripsy is a new and promising nonsurgical therapy for selected cases of sialolithiasis of the large salivary glands.

Adult↗

PubMed1992

[Scintigraphic imaging of head and neck cancers with 99m technetium (v) dimercaptosuccinic acid. A prospective clinical study].

In patients with cervical metastases conventional examination by ultrasound, CT or MRI imaging often fails to identify an unknown primary tumor. Also the retrieval of a recurrent malignancy may be difficult. Scintigraphy, utilizing technetium-99m (v) dimercaptosuccinic acid was chosen for a prospective study in 17 patients to evaluate its properties for imaging metastasizing squamous cell carcinoma of the head and neck. Scintigraphic findings were correlated with the results of clinical examination and conventional imaging techniques. In all cases the primary tumor revealed good uptake of 99mTc(v)DMSA. Manifest cervical metastases could only be imaged in some cases. In future, therefore, 99mTc(v)DMSA scanning may be used for the detection of unknown primary tumors. However, it does not appear helpful in the evaluation of cervical nodes.

Carcinoma, Squamous Cell↗

PubMed1992

[Pleomorphic adenoma of the epiglottis. Case report and review of the literature].

A rare case of a pleomorphic adenoma of the epiglottis in an 82-year-old patient is presented. Resection of the tumor was accomplished by using the CO2-laser and required a partial epiglottectomy. Postoperatively there were no functional impairments. This is the third case of a pleomorphic adenoma of the epiglottis, published in literature, but the first case in which epiglottectomy was performed by endoscopic laser resection.

Adenoma, Pleomorphic↗

PubMed1992

[Sonography and plain roentgen image in diagnosis of salivary calculi--experimental studies].

A model was developed in which high-resolution real-time sonography was compared with radiological examinations for determining their sensitivity in diagnosing salivary gland stones. For this purpose an artificial salivary gland medium was compared with human salivary gland tissue for echogenicity. It was shown that both the artificial and the true salivary gland medium possessed comparable acoustic properties. Forty salivary gland stones were examined ultrasonographically in both media with 5 and 7.5 MHz linear scanners and a 5 MHz sector scanner, following which a plain X-ray was done, while 35 of 40 calculi could be definitely identified with linear scanners in both media, this could be accomplished by X-ray only in 50% (20 of 40 calculi). All salivary gland stones greater than 1-2 mm could be detected ultrasonographically, whereas radiological identification did not correlate with stone size. Mineral composition was found to influence the radiological study but not sonographic pictures of sialoliths. If sialolithiasis is suspect clinically, ultrasonography with a linear scanner must be considered the diagnostic procedure of choice.

Humans↗

PubMed1992

[Ultrasound diagnosis of skin tumors].

Twenty-one patients with skin tumors were examined before and after operation using special high-frequency ultrasound B-scanners. The different histological types were related to sonographic phenotypes, and the extent of tumors in the ultrasound image was comparable with that seen on the histometric image. The extent and invasion depth of skin tumors were assessed correctly by ultrasound.

Basal Cell Carcinoma↗

PubMed1992

[Ultrasonic diagnostics of the external nose].

Twenty megahertz ultrasound B-scanners achieve an axial resolution of 80 microns. The range of 7 mm in soft tissue suffices for imaging of dermal and cartilaginous structures with anatomical precision, and the form, position and diameter of the cartilaginous structures of the nose can be assessed. Distinct echoes within the cartilage indicate inflammation or trauma. The position, scarring and rate of resorption of implants can be observed non-invasively.

Adult↗

PubMed1991

Neutrophils express the high affinity receptor for IgG (Fc gamma RI, CD64) after in vivo application of recombinant human granulocyte colony-stimulating factor.

Fc receptors are important effector molecules of neutrophilic granulocytes (polymorphonuclear neutrophils [PMN]), connecting phagocytic cells and the specific immune response. Neutrophils from healthy donors express the low-affinity receptors for IgG Fc gamma RII (CD32) and Fc gamma RIII (CD16), but not the high-affinity receptor Fc gamma RI (CD64). The latter has been found on neutrophils from patients with certain bacterial infections and can be induced in vitro after incubation with interferon-gamma. We show here that neutrophils strongly express Fc gamma RI after in vivo application of recombinant human granulocyte colony-stimulating factor (rhG-CSF). PMN from patients receiving rhG-CSF displayed higher cytotoxicity against Daudi lymphoma cells in vitro compared with control patients and with healthy donors. Fab fragments against Fc gamma RII (monoclonal antibody [MoAb] IV.3) inhibited neutrophil-mediated cytotoxicity of healthy donors but not of patients during rhG-CSF therapy. Therefore, expression of Fc receptors by PMN was investigated by flow cytometry and the mean fluorescence intensity (MFI) was compared. After staining with MoAb 32.2 against Fc gamma RL, the median MFI of neutrophils from G-CSF patients (median, 4.78; range, 2.40 to 8.50; n = 5) was significantly higher (P = .002 and P = .001, respectively) than the median MFI of patients not receiving G-CSF (median, 1.23; range, 1.01 to 1.58; n = 6) and the median MFI of healthy donors (median, 1.04; range, 0.67 to 1.12; n = 6). Fc gamma RI disappeared after the discontinuing of the G-CSF injections, but was reinduced during the next treatment cycle with rhG-CSF. The high expression of Fc gamma RI during rhG-CSF therapy correlated with enhanced cytotoxicity. In vitro incubation with rhG-CSF also enhances cytotoxicity, but only minor increments in Fc gamma RI expression were observed. Thus, during in vivo application of rhG-CSF neutrophils acquire an additional potent receptor for mediating tumor cell killing in vitro by induction of the high-affinity receptor for IgG (Fc gamma RI, CD64).

Antibodies, Monoclonal↗

PubMed1991

Percutaneous endoscopically guided gastrostomy in patients with head and neck cancer.

In 212 patients with tumors in the head and neck region the nutritional status prior to, during, and following radiotherapy, was determined by body measurements and biochemical and immunological parameters. In 165 orally fed patients the nutritional parameters deteriorated rapidly under radiation and afterwards recovered only slowly and incompletely, 31 patients requiring PEG during radiotherapy. By contrast, 47 patients with a poor initial status who had a prospectively performed percutaneous endoscopically guided gastrostomy (PEG) experienced an amelioration of their nutritional status even before radiotherapy ended. The subjective status of the patients was assessed using the Padilla quality of life index. Here, too, the PEG patients had significantly worse initial values than the orally fed patients. As with the objective indicators of nutritional status a significant deterioration was seen in the orally fed patients during radiotherapy, while the scores of the PEG patients remained constant. We consider early institution of a carefully monitored enteral feeding by PEG useful for stabilizing the nutritional status of patients with tumors in the head and neck region, and therefore recommend, when aggressive multimodal therapy is planned-and particularly if primary malnutrition is already obvious-prophylactic performance of PEG prior to the start of therapy.

Adult↗