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Biomedical subjects

L Tran

Publications and source records attributed to L Tran.

45 records · Page 3Linked to original sources

Malignant salivary gland tumors of the paranasal sinuses and nasal cavity. The UCLA experience.

Between 1962 and 1985, 35 patients with malignant salivary gland tumors of the paranasal sinuses and nasal cavity were treated with curative intent at UCLA. They were staged according to the American Joint Committee (TNM) classification for squamous cell carcinoma of the paranasal sinuses: 27 of 35 (77%) patients presented with T3-4 disease. Adenoid cystic carcinoma was the diagnosis in 24 (68%) patients, while adenocarcinoma accounted for half of the cases involving the ethmoid sinuses and nasal cavity. Eleven patients were treated with surgery alone, 13 with combined surgery and radiation, and 11 with radiation therapy alone. All patients were followed from 40 to 216 months. Analysis by treatment modality revealed a local control of 18% (2 of 11) in the surgery alone group, 62% (8 of 13) in the combined group, and 9% (1 of 11) in the radiation alone group. The group undergoing combined treatment achieved the highest local control rate despite having a higher proportion of patients with advanced stage and residual disease at the surgical margins. In patients with positive surgical margins, the tumor recurred locally in 4 of 6 (67%) unirradiated patients, compared with 3 of 10 (30%) of those undergoing postoperative irradiation. Patients with adenoid cystic carcinoma had poorer results, with only 25% remaining relapse-free, compared with 45% of patients with adenocarcinoma. The 5-, 10-, 15-, and 20-year actuarial survival for all cases was 73%, 60%, 32%, and 20%, respectively. We conclude that post-operative radiation improves the results of treatment in all patients with malignant salivary gland tumors in this location, compared with the results of surgery alone.

Adenocarcinoma↗

Effect of experimental azotemia on intestinal transport of butyric acid.

Earlier studies have revealed an impairment of jejunal absorption of long chain fatty acids in experimental uremia. We investigated the intestinal absorption of butyric acid which is a short chain fatty acid in experimental renal failure (RF). Sprague-Dawley rats were randomized into the RF group which had subtotal nephrectomy, a sham-operated control group, and a pair-fed group. In vivo recirculating perfusion (n = 5) and in vitro everted sac incubation (n = 8) were employed. The in vitro experiments were repeated substituting the serosal buffer by either predialysis or postdialysis sera from uremic individuals, or normal serum (n = 10). The rate of in vivo butyric acid absorption was significantly lower while the in vitro absorption was significantly higher in the RF group than those observed in the sham-operated and pair-fed groups which showed comparable values. The normality of butyric acid absorption in the pair-fed animals despite comparable weight loss with the RF group tends to exclude anorexia and weight loss as a cause of altered butyric acid transport in RF animals. The disparity between the in vivo and in vitro data is suggestive of an inhibitory influence of uremic environment which is present in vivo and absent in vitro. This viewpoint was corroborated by the observed fall in butyric acid absorption by sacs containing predialysis uremic serum as compared with those containing normal or postdialysis sera. The latter further suggests that the inhibitory factor(s) is dialyzable.

Animals↗

Endocrine and hemodynamic effects of antagonism of fentanyl-induced respiratory depression by nalbuphine.

Endocrine and hemodynamic changes associated with the antagonism of fentanyl by nalbuphine have not been reported. Therefore, the authors studied ten patients after anesthetic induction with thiopental, fentanyl, tracheal intubation aided by succinylcholine and maintenance with diazepam, pancuronium, N2O, and further doses of fentanyl. Eight of the patients underwent cholecystectomy, one had a hysterectomy, and another had an abdominoplasty. After reversal of neuromuscular block at the conclusion of surgery, normal ventilation was restored by 0.22 +/- 0.02 mg/kg intravenous nalbuphine (mean +/- SEM). Plasma levels of free norepinephrine, histamine, and cortisol did not increase after antagonism of the fentanyl-induced respiratory depression, but plasma concentration of epinephrine increased significantly but without significant hemodynamic changes. Minute ventilation was 1.5 +/- 0.4 L/min before and 11 +/- 1, 10 +/- 1, 11 +/- 1, and 10 +/- 1 L/min at 15, 30, 45, and 60 min after antagonism; corresponding PaCO2 levels were 56 +/- 2, 44 +/- 1, 49 +/- 7, 49 +/- 1, 42 +/- 1 mm Hg. The mean analogue pain score remained below 1.5. We conclude that nalbuphine effectively antagonizes fentanyl-induced respiratory depression without adverse endocrine and circulatory changes or loss of analgesia.

Adult↗

Salivary gland tumors of the palate: the UCLA experience.

A retrospective review of 38 patients with salivary gland tumors of the palate treated between 1961 and 1984 is presented. The majority of tumors were identified at an early stage. Most (23 of 38 cases) originated over the hard palate. The most common histological type was adenoid cystic carcinoma (22 cases). Twenty-five patients were treated with surgery alone, of whom, three had wide local excision. Thirteen patients received postoperative radiation therapy in addition to surgery. The local control was comparable for surgery alone and combined therapy (88% and 85%, respectively) although the combined therapy group was biased by more advanced disease, inadequate margins, and/or poorly differentiated histologies. Mucoepidermoid lesions had an excellent prognosis with local control of 100%. In contrast, there was a 23% recurrence rate for adenoid cystic carcinoma. Regional neck node metastasis was noted in 2% of the patients. This experience indicates that radical resection of palate salivary gland malignancy with adequate margins results in excellent local control. Adjuvant radiation therapy is recommended in cases where there is a question of adequate margins and in advanced lesions of high grade tumors.

Adenocarcinoma↗

Value of radiation therapy in addition to surgery for cancer of the head and neck.

This historically controlled study evaluates radiation therapy in 119 patients--with squamous cell carcinomas of the head and neck--who underwent surgery alone (SA) or surgery plus radiation (S + R). The primary tumor control and nodal control, in patients with negative surgical margins who had surgery alone (SA), were 63% in the oral cavity, 60% in the oropharynx, and 67% in the hypopharynx. The same rates for S + R group and negative surgical margins were 100%, 73%, and 100%. Combining the patients with negative and positive surgical margins, control of the tumor and nodal control were the same in the oral cavity for both treatment groups (41% for SA and 44% for S + R) and increased with the addition of radiation in the oropharynx (30% for SA to 65% for S + R) and hypopharynx (33% for SA to 86% for S + R), in spite of higher percentages of T3 and T4 tumor and positive lymph nodes in the S + R group. The lower control rate in patients who had surgery alone could be due (in part) to inadequate surgery at the primary site (42% local excision) and lack of neck dissection (35% for SA vs. 77% for S + R). Postoperative radiation therapy to the primary site and neck is shown to effectively reduce local recurrence in patients with oral cavity and oropharynx cancer, regardless of surgical margins.

Carcinoma, Squamous Cell↗

Major salivary gland tumors: treatment results and prognostic factors.

A retrospective review of 133 patients with major salivary gland carcinomas treated between 1955 and 1981 is presented. The majority of cases (104) originated in the parotid gland. The most common histological type was mucoepidermoid carcinoma (39 cases). Tumor-free interval was longest for patients with acinic cell and mucoepidermoid carcinomas. In contrast, adenoid cystic carcinoma was poorly controlled, regardless of the form of treatment. Initial control of primary major salivary gland tumors was inversely related to the presence of disease at the surgical margins. In cases with microscopic or gross disease at the surgical margins, postoperative radiation therapy controlled the tumor locally in 18 of 26 patients (69%). Postoperative radiation therapy was generally used only in cases with high-grade histologies, advanced stages, or positive surgical margins. Of the patients treated with surgery alone, 53% achieved local control, as compared to 75% of the group which received postoperative radiation therapy. Although the difference was not statistically significant, we would have expected the combined therapy group to have a lower control rate due to more advanced disease. There was a low salvage rate (22%) and a high incidence of distant metastasis (60%) in recurrent cases. The data indicates that complete surgical resection results in the best local control, with or without adjuvant radiation. When the surgical margin is inadequate and re-excision not possible, adjuvant radiation therapy appears to have a role to optimize local control and survival.

Adolescent↗

Concentrations of high-mobility-group proteins in the nucleus and cytoplasm of several rat tissues.

Nuclear and cytoplasmic fractions were isolated from various tissues of the rat by a nonaqueous technique. The high-mobility-group (HMG) proteins were extracted from these fractions with acid and separated by one- and two-dimensional PAGE. The concentrations of high-mobility-group proteins HMG1, HMG2, and HMG17 in the nucleus and cytoplasm were then estimated from the staining intensities of the electrophoretic bands. The cytoplasmic concentrations of these proteins were very low--usually less than 1/30 of those present in the corresponding nuclear fractions. For the tissues studied (liver, kidney, heart, and lung), the concentrations of HMG proteins in the nucleus did not differ significantly from one tissue to another. Averaged over the four tissues investigated, there were 0.28 molecule of HMG1, 0.18 molecule of HMG2, and 0.46 molecule of HMG17 per nucleosome. These values are considerably higher than those that have been reported previously.

Animals↗

Threshold of toxicological concern for chemical substances present in the diet: a practical tool for assessing the need for toxicity testing.

The de minimis concept acknowledges a human exposure threshold value for chemicals below which there is no significant risk to human health. It is the underlying principle for the US Food and Drug Administration (FDA) regulation on substances used in food-contact articles. Further to this, the principle of Threshold of Toxicological Concern (TTC) has been developed and is now used by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) in their evaluations. Establishing an accepted TTC would benefit consumers, industry and regulators, since it would preclude extensive toxicity evaluations when human intakes are below such threshold, and direct considerable time and cost resources towards testing substances with the highest potential risk to human health. It was questioned, however, whether specific endpoints that may potentially give rise to low-dose effects would be covered by such threshold. In this review, the possibility of defining a TTC for chemical substances present in the diet was examined for general toxicity endpoints (including carcinogenicity), as well as for specific endpoints, namely neurotoxicity and developmental neurotoxicity, immunotoxicity and developmental toxicity. For each of these endpoints, a database of specific no-observed-effect levels (NOELs) was compiled by screening oral toxicity studies. The substances recorded in each specific database were selected on the basis of their demonstrated adverse effects. For the neurotoxicity and developmental neurotoxicity databases, it was intended to cover all classes of compounds reported to have either a demonstrated neurotoxic or developmentally neurotoxic effect, or at least, on a biochemical or pharmacological basis were considered to have a potential for displaying such effects. For the immunotoxicity endpoint, it was ensured that only immunotoxicants were included in the database by selecting most of the substances from the Luster et al. database, provided that they satisfied the criteria for immunotoxicity defined by Luster. For the developmental toxicity database, substances were selected from the Munro et al. database that contained the lowest NOELs retrieved from the literature for more than 600 compounds. After screening these, substances showing any effect which could point to developmental toxicity as broadly defined by the US were recorded in the database. Additionally, endocrine toxicity and allergenicity were addressed as two separate cases, using different approaches and methodology. The distributions of NOELs for the neurotoxicity, developmental neurotoxicity and developmental toxicity endpoints were compared with the distribution of NOELs for non-specific carcinogenic endpoints. As the immunotoxicity database was too limited to draw such a distribution of immune NOELs, the immunotoxicity endpoint was evaluated by comparing immune NOELs (or LOELs-lowest-observed-effect levels-when NOELs were not available) with non-immune NOELs (or LOELs), in order to compare the sensitivity of this endpoint with non-specific endpoints. A different methodology was adopted for the evaluation of the endocrine toxicity endpoint since data currently available do not permit the establishment of a clear causal link between endocrine active chemicals and adverse effects in humans. Therefore, this endpoint was analysed by estimating the human exposure to oestrogenic environmental chemicals and evaluating their potential impact on human health, based on their contribution to the overall exposure, and their estrogenic potency relative to endogenous hormones. The allergenicity endpoint was not analysed as such. It was addressed in a separate section because this issue is not relevant to the overall population but rather to subsets of susceptible individuals, and allergic risks are usually controlled by other means (i.e. labelling) than the Threshold of Toxicological Concern approach. (ABSTRACT TRUNCATED)

Animals↗

Salvage radiotherapy for biochemical and clinical failures following radical prostatectomy.

PURPOSE: The proportion of prostate cancer patients undergoing radical prostatectomy has increased over the past 10 to 15 years. It is conceivable that a corresponding increase in local tumor recurrences after prostatectomies will be observed. The role of salvage radiotherapy is presently unclear. In this study, the results of salvage radiotherapy for patients with biochemical evidence of local recurrence, as evidenced from rising prostate-specific antigen (PSA) levels, after radical prostatectomy at UCLA Medical Center and the West Los Angeles Veterans Administration Medical Center are described. PATIENTS AND METHODS: Between 1990 and 1997, 69 patients were diagnosed with presumed local tumor recurrence after radical prostatectomy. Of these patients, 60 patients were referred to radiotherapy for salvage treatments. Tumor recurrence was detected biochemically, with or without a palpable nodule on digital rectal examination, and a metastatic workup revealing no evidence of extrapelvic disease. Biochemical failure after salvage radiotherapy was defined as two consecutive rises in serum PSA level after a PSA nadir or an absence of a PSA nadir after radiation treatments, as was earlier defined at the ASTRO Consensus Panel on PSA Guidelines. Patients referred for adjuvant postoperative radiation treatment and patients with metastatic disease at presentation were excluded from the study. Patients were treated with a four-field approach (anteroposterior/posteroanterior and opposing laterals) to a median dose of 64.8 Gy in 1.8-Gy fractions. Follow-up evaluations included serum PSA level and digital rectal examination every 3 to 6 months. RESULTS: At last follow-up (mean follow-up, 36 months after salvage radiotherapy), 40 of 60 patients (67%) were biochemically free of disease. Thirty of 60 patients (50%) had undetectable PSA levels, and 55 of 60 (92%) had achieved some initial decrease after salvage radiation treatments. Three-year and 5-year actuarial biochemical disease-free survival was 63% and 55%, respectively. Of the 20 patients with biochemical failure after salvage radiation therapy, 10 patients (50%) developed distant metastases, and two (10%) patients were found to have persistent local disease. The mean time to biochemical relapse after salvage radiotherapy was 10 months, and the mean time to distant metastasis after salvage radiotherapy was 20 months. Evaluation of the remaining eight biochemical failures (43%) revealed no evidence of local disease progression or distant metastasis to date. Univariate and multivariate analyses revealed that both PSA > 1.0 ng/mL at the time of salvage radiotherapy and perineural invasion significant prognosticators for biochemical relapse after salvage radiotherapy. Likewise, both univariate and multivariate analyses revealed that prognosticators for distant metastasis included seminal vesicle invasion and perineural invasion. DISCUSSION: Salvage radiation therapy is a viable option for post prostatectomy local tumor recurrences. Of the patients who fail biochemically after salvage radiotherapy, 50% were eventually found to have distant metastases. In addition, biopsy-proven local recurrence after-prostatectomy was found not to confer an adverse outcome after salvage radiotherapy.

Analysis of Variance↗