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Biomedical subjects

R S Weber

Publications and source records attributed to R S Weber.

At least 91 records · Page 5Linked to original sources
PubMed1988

Effect of epidermal growth factor (EGF) on a newly established head and neck squamous carcinoma cell line.

A new cell line designated 584A2 has been recently established from a patient with squamous cell carcinoma of the larynx. Cytogenetic analysis of the cell line revealed multiple copies of chromosome 7, as well as a homogeneous staining region (HSR) on one chromosome 7. Since overexpression of epidermal growth factor (EGF) cell surface receptors (EGFr) often occurs in other squamous carcinoma cell lines, it was predicted that 584A2 might overexpress EFGr. This was confirmed by: (1) metabolic labeling, with subsequent immunoprecipitation of EGFr and comparing autoradiographs to a cell line without an HSR and fewer copies of chromosome 7, and (2) performing EGF binding assays with Scatchard analysis. Since overexpression of EGFr correlates with an inhibitory effect of EGF on cell culture, the biological effects of EGF on 584A2 were examined in this study. At 5 ng/ml (serum-free medium), EFG stimulated incorporation of [3H] thymidine into trichloroacetic acid-precipitable material compared with controls. Incorporation increased between days 0 to 1 and 1 to 2 days with a 6- to 7-fold maximum. Dose-response studies (0 to 100 ng/ml) indicated maximum incorporation (6- to 7-fold) occurred between 0.1 ng/ml and 1.0 ng/ml. Cell growth was monitored over 7 days and, during this time, 5 ng/ml EGF produced a 10- to 12-fold increase in absolute cell numbers when compared with controls. We concluded that, unlike other squamous carcinoma lines with elevated EGFr, EGF stimulates rather than inhibits 584A2 cell proliferation.

Carcinoma, Squamous Cell↗
PubMed1988

The relationship of circulating IgA to cellular immunity in head and neck cancer patients.

The relationship of circulating IgA titers and multiple parameters of cell-mediated immunity was examined in 97 patients with head and neck cancer. In 26% of the patients, IgA titers were above one standard deviation of controls, with highest levels noted in patients with advanced disease. In 40 patients for whom multiple immune parameters were tested in vitro, increasing concentrations of IgA were associated with an enhanced immunologic helper state defined by a generalized hypergammaglobulinemia, increased percentage of T4+ lymphocytes, higher T4/T8 ratio, and an increased lymphocyte blastogenesis response to mitogens. IgA concentrations were inversely related to percentages and absolute number of Leu 11+ natural killer cell subsets, and also to disease-free survival (p less than 0.005 by Cox proportional hazards model). The immune correlations identified here are similar to those noted in many autoimmune diseases. Head and neck cancer patients are an immunologically heterogeneous population, among whom elevated IgA blood levels may reflect the autoimmune nature of cancer, an immunologic state defined by its tumor-promoting capacity.

Adult↗
PubMed1988

Wound prophylaxis with metronidazole in head and neck surgical oncology.

Anaerobic organisms are thought to be an important source of wound infection in head and neck oncologic surgery. Antibiotic prophylaxis consisting of agents specific for anaerobes combined with broad-spectrum agents that provide coverage for other well-recognized pathogens should be an effective combination regimen for this group of patients. We conducted a prospective, randomized study comparing the efficacy of prophylaxis using combination of metronidazole and cefazolin-designated group A, to prophylaxis using cefazolin alone-group B, for patients undergoing oncologic procedures of the head and neck. The rate of wound infection in the cefazolin-metronidazole group (158 patients) was 9.5%, compared with 18.6% in the cefazolin group (172 patients) (p = 0.03). Patients undergoing clean procedures had a 4.9% infection rate overall, compared with 17.9% for clean-contaminated procedures, and 33.3% for contaminated procedures. The average length of hospitalization was 20.7 days for patients who developed infections, compared with 8.9 days for patients without infection. Anaerobic organisms were cultured in 12 of 26 patients, ten of whom did not receive metronidazole. The lower rate of wound infection among patients who received metronidazole suggests that anaerobic organisms are an important source of wound infection in head and neck oncologic surgery. Chemoprophylaxis for these patients should, therefore, include specific anaerobic coverage in addition to the broad-spectrum agents that cover the more familiar aerobic organisms.

Bacteria, Anaerobic↗
PubMed1987

Split calvarium cranioplasty.

Fronto-orbital deformities secondary to trauma, infection, or surgery create a difficult problem for the reconstructive surgeon. The location of the deformity is particularly critical because it involves the most visible part of the face. Since the skull is rarely able to produce bony regeneration over large areas, numerous alloplastic materials have been used to repair these defects. Complications with these materials are commonplace. Autogenous bone has been used with good results and avoids many of the problems inherent to the use of foreign materials. Rib, scapula, and iliac crest may be used, but they require a separate incision and often provide less than satisfactory cosmetic results. We describe a technique of cranioplasty utilizing split calvarium for repair of frontal bone defects. Cosmesis is excellent, morbidity is minimal, and only one incision is necessary.

Adult↗
PubMed1987

Treatment of invasive Aspergillus sinusitis with liposomal-amphotericin B.

Invasive sinonasal aspergillosis is a severe and frequently fatal infection in immunosuppressed patients with hematologic malignancies. Seven patients with sinonasal aspergillosis who failed to respond to conventional amphotericin B (AmpB) were treated with liposomal AmpB (L-AmpB).AmpB was incorporated into multilamellar vesicles consisting of dimyristoyl phosphatidyl-choline and dimyristoyl phosphatidylglycerol in a 7:3 molar ratio. Five patients had underlying hematologic malignancies, one patient had aplastic anemia, and one patient had no underlying disease. All patients had biopsy-proven invasive Aspergillus sinusitis, and had failed conventional antifungal therapy including AmpB. Five patients were cured and two did not respond to treatment. Fever and chills were infrequent and, when they occurred, mild, and responded well to conventional management. No severe renal or central nervous system toxicity was observed. L-AmpB is effective and less toxic than conventional AmpB in the treatment of invasive Aspergillus sinusitis.

Amphotericin B↗
PubMed1986

Soft tissue sarcomas of the head and neck in adolescents and adults.

Between 1960 and 1982, 188 patients were treated for soft tissue sarcomas of the head and neck. These patients had a heterogeneous group of neoplasms whose biologic behavior was determined by histologic classification, differentiation, and size. Histologic classification of these tumors was important and had prognostic significance. Differentiation affected local control and the propensity for distant metastases. Tumor size also contributed to outcome: patients with tumors of more than 5 cm had a worse survival than those with smaller sarcomas. Wide surgical excision with an adequate margin of normal tissue offered the best means of local control. The addition of postoperative radiotherapy was utilized for patients with positive margins or high grade aggressive sarcomas. Finally, despite multimodality therapy, achieving local control and prevention of distant disease in high grade sarcomas remains a major therapeutic challenge.

Adolescent↗
PubMed1984

Sensorineural hearing loss associated with ulcerative colitis. A case report.

Autoimmune sensorineural hearing loss was first described in 1979. This may be secondary to a systemic autoimmune disease, or in some cases, to a direct autoimmune insult to the labyrinth. A case of active ulcerative colitis and progressive sensorineural hearing loss responded to corticosteroid therapy.

Autoimmune Diseases↗
PubMedDate not supplied

Juvenile nasopharyngeal angiofibroma: an update of therapeutic management.

BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasopharynx composed of fibrous connective tissue and an abundance of endothelium-lined vascular spaces. The name of the disease is derived from the fact that it occurs during adolescence, almost exclusively in boys. METHODS: This study examines the natural characteristics of JNA, the imaging techniques used to diagnose and stage the neoplasm, and the treatment approaches used to manage the disease. RESULTS: Forty-three cases of JNA diagnosed and treated at the University of Texas M. D. Anderson Cancer Center over a 38-year period were reviewed for the study. The cases were divided into two groups, those occurring between 1955 and 1974 and those occurring between 1975 and 1991, to accurately represent the developments in diagnostic and treatment methodology during those time periods. CONCLUSION: The results of our study show that: (1) the imaging techniques used after 1965 (angiography, computed tomography, and magnetic resonance imaging) greatly improve the staging of JNA; (2) morbidity, recurrence, and intraoperative complications decrease when preoperative embolization and skull-based surgical approaches are used; and (3) surgical resection is the most common primary treatment, with chemotherapy and radiotherapy recommended as possible other options.

Adolescent↗
PubMedDate not supplied

Whole salivary flow rates following submandibular gland resection.

BACKGROUND: Patients with head and neck neoplasms receive therapeutic neck dissections which may include the submandibular gland unilaterally or bilaterally. The clinical consequences of salivary gland resection could be reduced salivary output, altered cariogenic microflora, and increased incidence of dental caries. METHODS: This investigation evaluated whole salivary flow rates of patients who had received unilateral (n = 29) or bilateral (n = 8) submandibular gland resections and compared them with noncancer control subjects (n = 29). RESULTS: Unstimulated and stimulated (paraffin) flow rates were significantly lower in both resection groups compared with those of the noncancer group, ranging from p < .002 to p < .02. Although flow rates were lower in the bilateral group than in the unilateral group, the differences between these two groups were statistically significant (p < .02) only for stimulated saliva. Xerostomia was reported by one third of the resection subjects. CONCLUSION: In view of the significantly lower flow rates observed in the resection groups (especially for unstimulated saliva), topical fluoride therapy should be considered for those patients whose past caries activity would indicate an increased caries risk associated with partial loss of salivary function.

Adult↗
PubMedDate not supplied

Neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy.

BACKGROUND: The role of neck surgery in node-positive patients whose primary tumors are treated by definitive radiotherapy is controversial. This analysis was undertaken to assess the risk of withholding planned neck dissection in patients who obtain a complete nodal response to irradiation. METHODS: We reviewed the records of 100 patients who presented between 1984 and 1993 with oropharyngeal cancers metastatic to the neck and whose primary tumors were treated by radiotherapy using the concomitant boost regimen. Seventy-five patients had their nodal disease treated definitively by radiotherapy; those who had complete clinical resolution of all nodal disease (62) had no planned surgery, while 13 underwent neck dissection for presumed residual disease. The remaining 25 patients had either node excision (8) or neck dissection (17) prior to radiotherapy. RESULTS: There were 8 cases of isolated neck failure of which 3 occurred in the 62 patients who had no planned neck surgery, 0 in the 13 patients who had surgery for presumed residual (pathologically negative in 7). and 5 in the 25 patients who had initial neck surgery. In those who obtained a complete response to definitive radiotherapy, the risk of neck relapse was unrelated to pretreatment nodal size. CONCLUSIONS: The policy of observation of the neck after complete nodal response to full-dose irradiation is both safe and cost effective. Imaging to confirm the resolution of nodal disease is recommended.

Adult↗
PubMedDate not supplied

Electrosurgical dissection to reduce blood loss in head and neck surgery.

We prospectively determined the intraoperative blood loss in 250 patients who underwent major head and neck surgical procedures over a 13-month period to demonstrate the efficacy of electrosurgical dissection for reducing blood loss and to determine those factors predictive of the need for blood replacement. Transfusions were required in 30 (12%) of the 250 patients, and a total of 66 units of packed red blood cells was administered. Two patients were transfused preoperatively, 16 patients intraoperatively, and 14 patients postoperatively. Factors predicting the necessity for blood replacement included the patient's preoperative hematocrit level, intraoperative blood loss, the duration and type of procedure, and the surgeon's level of experience. The principles of electrosurgical dissection are discussed.

Adolescent↗
PubMedDate not supplied

Temporal bone involvement by prostatic adenocarcinoma: report of two cases and review of the literature.

Although axial bone and cranial metastases are common in patients with prostatic carcinoma, temporal bone involvement is rare. We report 2 cases of prostatic adenocarcinoma with temporal bone metastasis and review the relevant literature. One case had a 3-year history of a prostatic carcinoma, whereas in the second case the temporal bone metastasis was the initial presentation. Awareness of the possibility of temporal bone involvement by prostate carcinoma and application of immunohistochemical studies will help to arrive at the correct diagnosis.

Adenocarcinoma↗
PubMedDate not supplied

Nasopharyngeal angiofibroma.

Based on this patient's history and the imaging studies, all the consultants agree that they are dealing with a juvenile nasopharyngeal angiofibroma. They agree that a biopsy is not necessary. However, angiography would be obtained by 2 physicians (Drs. Seid and Weber). When treating an extensive JNA, the consultants differ in their approaches. One favors a lateral infratemporal fossa approach (Dr. Gantz), but the others favor a combined approach (Drs. Seid and Weber). In this particular case, 2 experts favor resection (Drs. Gantz and Weber), but one would irradiate (Dr. Seid). There is also disagreement regarding the severity of morbidity. Minor problems include conductive hearing loss, paresis of the third division of the fifth cranial nerve (Dr. Gantz), and a transient facial nerve paralysis (Dr. Weber). They are more concerned about the long-range problems from skull-base radiotherapy including brain-stem compromise, pituitary dysfunction, and radiation-induced malignancies. No one suggests chemotherapy or multimodal therapy. Regarding the natural history of JNA, the views range from no spontaneous regression (Dr. Gantz), gradual involution over time (Dr. Seid), or an indolent nature that requires tapering the treatment to the benign nature of the process (Dr. Weber).

Adolescent↗
PubMedDate not supplied

Metastatic thyroid cancer as an incidental finding during neck dissection: significance and management.

Occult thyroid cancer is an occasional incidental finding during surgery for other indications and is usually considered of minor clinical significance; however, the appropriate approach for incidentally found metastatic thyroid cancer is less clear especially when it occurs in the context of another malignancy that has more aggressive potential. Among 2,855 patients treated for squamous cancer of the tongue at The University of Texas M. D. Anderson Cancer Center, eight patients had coexisting differentiated thyroid cancer metastatic to cervical lymph nodes which was found incidentally during regional lymph node dissection. The eight patients included three women and five men with a median age of 47 years (range, 32-62 years); tumors were of the papillary variety in four patients and follicular in the other four. In one patient, no gross or microscopic primary tumor could be identified after thyroidectomy; in another patient, no gross tumor was evident, but whole organ section revealed an area of fibrosis consistent with a primary lesion. Two patients had primary lesions less than 1 cm in maximal diameter. In four patients who had no surgery, physical exam and radiologic evaluation failed to show any intrathyroidal lesions. Clinically relevant thyroid cancer did not develop in any of those patients during the duration of documented follow-up (1-15 years). Three patients died of progressive tongue cancer, one patient of unrelated pulmonary disease, and four patients remain alive without evidence of disease for 1 to 15 years of available follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMedDate not supplied

Carcinomas of the lacrimal drainage system.

Primary carcinomas of the lacrimal drainage system are rare. These malignant neoplasms typically present as noncompressible, nontender masses with low-grade dacyrocystitis and/or unilateral epiphora. Lymph node metastasis may occur late in the disease course. Complete surgical resection is the best treatment choice; extensive procedures such as orbital exenteration and maxillectomy may be necessary for complete tumor extirpation. Further adjunctive radiotherapy may improve local control. We present two cases of carcinoma of the lacrimal drainage system, including one locally controlled tumor with apparent lymph node metastasis that occurred 21 years after primary treatment. A review of the histopathology and literature concerning carcinomas of the lacrimal drainage system is presented.

Adult↗
PubMedDate not supplied

Bacteriologic profile of surgical infection after antibiotic prophylaxis.

Wound infections resulting from contamination during major head and neck surgery continue to be a critical issue. In this study, specimens of pus or draining fluids from the wounds of 43 surgical patients who received perioperative administration of ampicillin/sulbactam or clindamycin were cultured for aerobic and anaerobic isolates to species level. Polymicrobial infections were identified in 13 of 43 patients (30%); 82% of isolates were aerobic organisms (45 of 55), and 18% were anaerobic or facultative species (10 of 55). Nine of 43 patients (21%) showed no bacterial isolates from cultured material. Independent of the primary site of malignancy or antibiotics used, nine of 25 isolates (36%) obtained from patients who underwent concomitant dental extractions, but only one of 24 (4%) who did not, developed anaerobic infections, (p < 0.001). The minimum inhibitory concentration of anaerobic isolates suggested sensitivity to the antibiotics used, and minimum bactericidal concentration data suggested that further postoperative doses may be required to adequately treat the heavily contaminated wounds. These data suggest that wound colonization following dental extraction procedures in clean contaminated head and neck surgery increases the risk of anaerobic infections. The use of a therapeutic dose and longer duration of perioperative antibiotics may be warranted.

Ampicillin↗
PubMedDate not supplied

Laryngeal preservation by induction chemotherapy plus radiotherapy in locally advanced head and neck cancer: the M. D. Anderson Cancer Center experience.

Standard treatment of locally advanced laryngeal, hypopharyngeal, and some oropharyngeal cancers includes total laryngectomy. In an attempt to preserve the larynx through induction chemotherapy, we conducted two consecutive phase II studies. From March 1986 to February 1991, 64 patients with advanced untreated but resectable head and neck cancer who would require total laryngectomy were enrolled on one of two cisplatin-based induction regimens: cisplatin-bleomycin-5-fluorouracil (PBF) in 31 patients and cisplatin-5-fluorouracil (PF) in 33; all received definitive radiotherapy. Surgery was reserved for patients who achieved less than a partial response to chemotherapy and patients with residual or recurrent disease after sequential chemotherapy plus radiotherapy. Overall complete plus partial response rates to both cisplatin-based regimens were comparable. The combined PF and PBF overall response rates were 75% for laryngeal cancer, 78% for hypopharyngeal cancer, and 75% for oropharyngeal cancer. Complete response rates after radiotherapy were 88%, 83%, and 50%, respectively. Neutropenia (< 1,000 cells/mm3) was the most common hematologic toxic effect: it occurred in 44% of patients who received PF and 16% of those who received PBF. Grade > or = 3 mucositis occurred in 50% of patients who received PF and 4% who received PBF. The data suggest that laryngeal preservation was feasible in all three primary-site subgroups. With follow-up of 15+ to 54+ months, 44% of patients with laryngeal cancer, 28% with hypopharyngeal cancer, and 22% with oropharyngeal cancer are alive with laryngeal preservation. The overall 2-year survival rates for patients with cancer of the larynx, hypopharynx, and oropharynx were 71%, 46%, and 38%, respectively.

Adult↗