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Biomedical subjects

S Charabi

Publications and source records attributed to S Charabi.

At least 37 records · Page 2Linked to original sources
PubMed1999

Management of intrameatal vestibular schwannoma.

The growth of purely intrameatal vestibular schwannoma (VS) was investigated, in the period 1973-96 in a series of 40 patients with 40 unilateral VS. In the present study, the material was analysed and updated. By the end of the observation period (mean 3.6 years), 27 tumours (67.5%) revealed growth and 13 tumours (32%) had no measurable growth. Four growth patterns were observed: (A) 15 tumours (37.5%) exhibited constant growth; (B) 13 tumours (32.5%) had no measurable growth; (C) 8 tumours (20%) revealed growth subsequent to a no-growth period; and (D) 4 tumours (10%) showed different growth patterns during the observation period. The annual diameter growth rate ranged between 00 mm/year and 6.5 mm/year and the mean diameter growth per year was 3.2 mm. The findings of the present study, especially those for group B (the non-growing tumours) and C (tumour growth subsequent to a silent period) bring into question the reliability of the results achieved by radiosurgery, as without any intervention it may be that no tumour growth occurs.

Adolescent↗
PubMed1999

Incidence of vestibular schwannomas.

OBJECTIVE: To determine the incidence of vestibular schwannoma (VS) in Denmark in a period of 191/2 years. STUDY DESIGN: Retrospective review of prospective registered data on all patients with VS operated on by the translabyrinthine, lateral suboccipital, or middle cranial fossa approach, as well as patients who were allocated to the "wait-and-scan" group. METHODS: Charts were reviewed and tabulated for age, extrameatal tumor extension, and date of diagnosis. The available data were divided into three periods: June 1976 to June 1983, July 1983 to June 1990, and July 1990 to December 1995. RESULTS: The number of newly diagnosed tumors in the first period was 278, corresponding to an incidence of 7.8 tumors/million population per year; in the second period 337, corresponding to an incidence of 9.4 tumors/million population per year; and in the third period 355, corresponding to an incidence of 12.4 tumors/million population per year. A significant increase in incidence of the newly diagnosed intracanalicular tumors in the second and third periods was observed. CONCLUSION: The increase in incidence of VS can probably be explained by the awareness among otolaryngologists of the diagnosis of VS and better access to computed tomography and magnetic resonance imaging scans. The observed increase in the diagnosis of the small and intrameatal tumor creates a clinical dilemma, whether to operate on tumors in this early stage or to allocate patients to the wait-and-scan group. This problem will still be relevant in the upcoming years, since the incidence of intrameatal and small VS is expected to increase.

Denmark↗
PubMed1998

[Benign neoplasms in the parotid gland in the county of Copenhagen 1986-1995].

In a ten year period from 1986-95 433 patients were submitted to operation due to benign tumours in the parotid gland in Copenhagen County. In this study we made a retrospective analysis of the surgical outcome. The incidence was calculated to be 6.8 benign tumours in the parotid gland per 100,000 persons per year. The histological distribution showed a frequency of 54% pleomorphic adenomas, 28% adenolymphomas and 18% other tumours. In the observation period there was a 3% recurrence rate in our material, most frequently the pleomorphic adenoma. The risk of permanent damage to the facial nerve was 1% for severe injury and 3% for affection of the ramus marginalis. Frey's syndrome was present in 50% of the patients, moreover the syndrome was observed many years after surgery. The frequency rate reached its highest level about five years postoperatively.

Adenolymphoma↗
PubMed1998

[Cervical necrotizing fasciitis].

Cervical necrotizing fasciitis is a rapidly progressive infection that involves the superficial and deep cervical fascia. Underestimation of this severe neck infection can delay diagnosis and treatment of this often fatal disease process. Three new cases, all with mediastinitis and fatal outcome are presented. Early diagnosis, aggressive surgical treatment and antibiotic therapy is essential if the high mortality rate is to be brought down in the future.

Aged↗
PubMed1998

Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results.

The Danish model for vestibular schwannoma (VS) surgery has been influenced by some historical otological events, taking its origin in the fact that the first attempt to remove CPA tumors was performed by an otologist in 1916. In approximately 50 years VS surgery was performed by neurosurgeons in a decentralized model. Highly specialized neuro- and otosurgeons have been included in our team since the early beginning of the centralized Danish model of VS surgery in 1976. Our surgical practice has always been performed on the basis of known and proven knowledge, but we spared no effort to search for innovative procedures. The present paper reflects the experience we have gained in two decades of VS surgery. Our studies on the incidence, symptomatology, diagnosis, expectancy and surgical results are presented.

Craniotomy↗
PubMed1998

Acoustic neuroma/vestibular schwannoma growth: past, present and future.

The growth of vestibular schwannoma (VS) was investigated in a series of 123 patients with 127 tumors in the period 1973 1993. The material was reanalysed and updated 3 years later in 1996. By termination of the first observation period (mean 3.4 years), 94 tumors (74%) exhibited measurable growth, 23 tumors (18%) no measurable growth and 10 tumors (8%) negative growth. By the end of the extended observation period (mean 3.8 years), tumor growth was observed in 104 tumors (82%), no tumor growth in 15 tumors (12%) and negative growth in eight tumors (6%). Several growth patterns were noticed: however, these were not static as the growth patterns of the tumors changed during the extended observation period. Accordingly, the expected growth figures by the end of this century (mean observation period approximately 4 years) will probably be: growth in 111 tumors (87%), no growth in 10 tumors (8%) and negative growth in six tumors (5%). The results indicate that neither the present study nor the previously published studies on tumor growth reflect the natural history of VS, but they only provide information on tumor growth, growth rates and growth patterns during a given observation period.

Adolescent↗
PubMed1997

Thallium chloride 201Tl combined with single photon emission computed tomography (SPECT) in the evaluation of vestibular schwannoma growth.

Thallium chloride 201Tl combined with SPECT was performed in a series of 29 patients with neuroradiological evidence of vestibular schwannoma (VS). The relative tumor uptake (U) and relative tumor concentration (C) of the radiotracer 201Tl was determined, and the cerebellum served as a reference. The relative tracer concentration and uptake were correlated to tumor volume determined by gadolinium DTPA enhanced MR, to prediagnostic duration of symptoms, to tumor vascularity expressed by the average number of intratumoral vessels using the endothelial marker CD31, and to the proliferative activity in the tumors expressed by positive staining with the monoclonal antibody MIB-1 for Ki-67. A positive 201TI enhancement was detected in 17 tumors (n = 17). Tumors U and C were statistically unrelated to tumor volume (p = 0.236 and p = 0.439). SPECT demonstrated all tumors > 0.8 cm3, but it had its limitation as a diagnostic modality of small intracanalicular tumors, when compared with gadolinium DTPA enhanced MR. Relating U and C in all tumors (n = 29) and the prospectively registered data on the prediagnostic duration of symptoms, a statistical significance was found (p = 0.012 and p = 0.015). No statistically significant correlation was observed between U and C and the proliferative activity of the tumors expressed by positive staining with the monoclonal antibody MIB-1 for Ki-67 (p = 0.063 and p = 0.086). A statistically significant correlation was noted between C and U in the operated group (n = 12) and tumor vascularity expressed by the average number of the intratumoral vessels (p = 0.003 and p = 0.014). SPECT was found to be superior to MR in determining VS growth potentials as it expresses tumor vascularity, which is essential for tumor growth. It seems that we now have an in vivo functional radiological modality capable of providing data on VS vascularity and determination of growth potential in the individual tumor. A high radioactive tracer uptake in the tumor corresponded to high tumor vascularity, indicating a high growth rate and vice versa.

Adult↗
PubMed1997

Increase of diagnosed vestibular schwannoma in Denmark.

The incidence of acoustic neuroma/vestibular schwannoma (VS) in Denmark, with a population of approximately 5 million inhabitants was estimated in 3 periods: June 1976-June 1983, July 1983-June 1990 and July 1990-December 1995. The incidence of tumors increased from 7.8 tumors per million per year in the first period to 9.5 tumors per million per year in the second period. The figure of 12 tumors per million per year is established in the third period. A significant increase of the newly diagnosed intracanalicular and small tumors, with an extracanalicular extension of 1-10 mm was observed in the third period compared with the first 2 periods. Correspondingly a decrease in the newly diagnosed giant tumors was noted in the last 2 periods compared with the first period.

Denmark↗
PubMed1997

Squamous cell carcinoma of the oral cavity: the results of the surgical and non-surgical therapeutic modalities in a consecutive series of 156 patients treated in Copenhagen county.

A retrospective study on patients, treated for intraoral squamous cell carcinoma in Copenhagen county, is reported. The material included 156 patients, 66 females and 90 males. Age at diagnosis varied between 35 and 95 years with a mean of 65 years. Mean age of females/males was 70/62 years. Twelve therapeutic modalities were performed; surgery, radiotherapy, chemotherapy and different combinations of these. Three and five years crude survival were 43% and 37%. Three and five years crude survival rates were 70% and 61% for patients in stage I, 39% and 32% for patients in stage II, 29% and 16% for patients in stage III and 19% and 17% for patients in stage IV. The results are similar to those achieved in other centers. Since no significant improvement has been noted in patient survival during the last 5-6 decades and since the therapeutic morbidity has not always been acceptable to the patients, other therapeutic principles such as the so-called minimal invasive therapy should be considered in future treatment of intraoral cancer.

Aged↗
PubMed1996

Nerve growth factor receptor expression in heterotransplanted vestibular schwannoma in athymic nude mice.

Nerve growth factor (NGF) has the potential to induce cellular differentiation in various neoplastic and non-neoplastic cell lines. The purpose of the present study was to determine by immunohistochemistry: the presence/distribution of nerve growth factor receptor (NGFr), cellular proliferation expressed by Ki-67, and intratumoral vascularization visualized by the endothelial marker CD 31, in a series of 61 human vestibular schwannoma heterotransplants in athymic nude mice. The immunohistochemical results were correlated to the observed macroscopic growth in 22 heterotransplants (36%) with obvious macroscopic growth, versus 39 heterotransplants (64%), that were stationary or regressed. The positive immunoreactivity to NGFr, number of Ki-67 positive nuclei and number of intratumoral vessels were significantly higher in the 22 (36%) growing heterotransplants than in the 39 heterotransplants (64%), which were stationary or regressed (p < 0.00005, p = 0.046, p < 0.00001). NGFr was statistically related to the vascularity of the heterotransplants expressed by CD 31 (p<0.00001). No significant relation was observed between NGFr and the proliferation, as estimated by Ki-67. The results revealed that the macroscopic growth of VS in athymic nude mice was associated with strong positive expression of NGFr, high cellular proliferation expressed by Ki-67 and vivid neovascularization expressed by CD 31. The possible clinical applicability of the achieved results is discussed.

Animals↗
PubMed1996

Growth of vestibular schwannomas: in situ model employing the monoclonal antibody Ki-67 and DNA flow cytometry.

Vestibular schwannoma (VS) growth potentials were studied in an in situ model, in which the cycling cellular fraction was determined immunohistochemically by applying the mouse monoclonal Ki-67 antibody, and the tumor ploidy was estimated by DNA flow cytometry in a consecutive series of 124 VSs. The tumors were classified according to the average number of positively stained nuclei in 10 high-power fields into three groups: 28 highly (> 10), 33 moderately (> 5-10) and 63 low proliferating (< or = 5). The intratumoral proliferative variation was studied in 10 tumors. Only slight variation in the number of the positively stained nuclei were observed. Six of seven tumors removed because of macroscopically documented growth by computed tomography (CAT) scan were moderately or highly proliferative. Proliferation of VS was correlated to prospectively registered clinical data. A statistically significant relation was found between VS proliferation and the prediagnostic duration of symptoms (p = 0.0001). The proliferative status was unrelated to age, sex, and tumor size. Flow-cytometric determination of DNA index of the 124 tumors revealed 12 tetraploid (DNA index = 2), 110 diploid (DNA) index = 1) and two nondiploid tumors. A statistically significant relation was noted between tumor ploidy and proliferation status expressed by Ki-67 (p = 0.024). The tetraploid tumors showed significantly lower proliferation compared with the diploid tumors. Tumor ploidy was statistically unrelated to age, sex, tumor size, and duration of symptoms. The results of this study provide a link between the immunohistochemical, flow cytometric findings, and clinical data, which could probably be relevant in identifying patients at risk for rapid tumor growth and tumor recurrences, because a rapid test for cell proliferation is now available.

Adult↗
PubMed1995

[Acoustic neurinomas/vestibular schwannomas. Diagnostic evidence vs. surgery].

+-f having vestibular schwannoma (VS) was conducted in a series of 123 patients (127 tumours), over a 20 year-period from 1973 to 1993. Mean follow up period was 3.4 years, mean annual growth rate was 3.2 mm/year. Tumour growth was observed in 90 patients (94 tumours, 74%), no growth was seen in 23 patients (23 tumours, 18%) and negative tumour growth in 10 patients (10 tumours, 8%). Surgery due to tumour growth was performed in 35 patients (35 tumours, 28%). Seven patients (seven tumours, 6%) were treated with gamma radiation and/or shunt insertion. Seven patients (6%) died of brainstem herniation induced by tumour compression. Nine patients (7%) died of non tumour related causes. Twenty-eight patients were classified as candidates for hearing preservation surgery and 21 patients (75%) lost their candidature during the observation period due to tumour growth and/or deterioration of hearing. The results may limit indications for allocation of patients with VS to the "wait and see" group.

Adolescent↗
PubMed1995

Acoustic neuroma (vestibular schwannoma): growth and surgical and nonsurgical consequences of the wait-and-see policy.

A prospective study of the consequences of the wait-and-see policy in in patients with neuroradiologic diagnostic evidence of having vestibular schwannoma was conducted in a series of 123 patients (127 tumors) over a 20-year period, from 1973 to 1993. The mean follow-up period was 3.4 years, mean annual growth rate was 3.2 mm/year, mean annual volume growth rate was 0.72 ml/year, and mean annual relative growth rate was 41%. Tumor growth was observed in 90 (74%) patients (94 tumors), no growth was seen in 23 (18%) patients (23 tumors), and negative tumor growth was seen in 10 (8%) patients (10 tumors). Surgery due to tumor growth was performed in 35 (28%) patients (35 tumors), 7 (6%) patients (7 tumors) were treated with gamma-radiation and/or shunt insertion, 7 (6%) patients died of brain stem herniation induced by tumor compression, 9 (7%) patients died of non-tumor-related causes, 28 patients were classified as candidates for hearing preservation surgery, and 21 (75%) patients lost their candidacy during the observation period due to tumor growth and/or deterioration of hearing. The results may limit indications for allocation of patients with vestibular schwannoma to the wait-and-see group.

Adolescent↗
PubMed1994

[Results of hearing preservation via middle fossa approach in surgery for acoustic neurinoma].

The results of hearing preservation surgery in a series of 10 patients with 10 unilateral acoustic neuromas are reported. Mortality was 0%, complications including rhinoliquorrhoea occurred in 10%, and the tumour was removed in 100%. Hearing preservation was obtained in 80%. Normal or nearly normal postoperative facial nerve function evaluated one year after surgery was achieved in all cases. According to House-Brackmann classification, 60% had HB-1 and 40% had HB-2. The fact that no audiovestibular or electrophysiological examinations are specific for acoustic neuroma can not be overemphasized. Early diagnosis of these small tumors in patients with good hearing has made this kind of surgery possible.

Adult↗
PubMed1994

[Extrapulmonary tuberculosis--important differential diagnosis].

In this paper, we present two cases of extrapulmonary tuberculosis, the first case with tuberculosis of the larynx and the second with tuberculosis lymfadenitis. In both cases malignant lesions were primarily proposed. We emphasize that definitive diagnosis requires culture and specification of Mycobacterium tuberculosis. We draw attention to the fact that extrapulmonary tuberculosis is still a differential diagnostic consideration.

Adult↗
PubMed1994

Cystic acoustic neuromas. Results of translabyrinthine surgery.

OBJECTIVE: This study was designed to investigate the surgical outcome of translabyrinthine surgery of cystic acoustic neuromas. DESIGN: Prospective registration of audiovestibular, otoneurologic, and neuroradiologic data of all patients operated on for cystic neuromas in the period 1976 to 1992. The diagnosis was proposed by neuroradiologic investigation, confirmed at surgery, and verified histologically. Clinical follow-up was performed 1 year after surgery. SETTING: The study included all patients with cystic acoustic neuromas from the entire country, referred to the centralized otoneurosurgical team in the Department of Otorhinolaryngology-Head and Neck Surgery, Gentofte University Hospital, and Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Denmark. PATIENTS: The study included 23 patients (11 female and 12 male). Ages ranged between 23 and 77 years with a median of 51.2 years. MAIN OUTCOME: Our hypothesis suggested that surgical outcome of cystic acoustic neuromas was poorer compared with noncystic acoustic neuromas of matching size. The results of this study seem to confirm the hypothesis. RESULTS: The results are rather poor compared with results achieved in surgery of noncystic tumors of matching size, particularly the poor postoperative facial nerve function. CONCLUSIONS: Even though the operation for a cystic acoustic neuroma may appear to be easier and faster than the operation for a solid tumor, there is a high risk for accidental lesion of the facial nerve, in spite of using facial nerve monitoring. Rapid symptomatic worsening may occur due to sudden expansion of cystic elements and, therefore, a wait-and-see policy should not be applied to patients with cystic tumors.

Adult↗
PubMed1994

Cystic vestibular schwannomas: neuroimaging and growth rate.

In a series of 571 vestibular schwannomas (VS) operated on in the period 1976-1992, via the translabyrinthine approach, 23 tumours (4 per cent) from 23 patients were radiologically, peroperatively and histologically identified as cystic VS. Neuroimaging examinations (CT and MRI) revealed 15 tumours (2.6 per cent) with extracystic formations and in eight cases (1.4 per cent) intratumoural cysts. In 15 cases (65 per cent), tumours were located extracanalicularly with no involvement of the internal auditory canal (IAC). The extracanalicular tumour extension including the cystic elements ranged between 10 and 60 mm with a mean of 45 mm. In eight cases out of 23 (35 per cent) other diagnostic possibilities such as trigeminal schwannoma, epidermoid cyst and meningioma were proposed at the primary evaluation. Deformation, displacement and/or impression of the fourth ventricle was demonstrated in 17 cases (74 per cent). Three patients (13 per cent) had obstructive hydrocephalus which demanded shunt insertion. Residual tumour was detected in two patients (9 per cent). Growth rate in four cases was more than 10 times higher when compared to the annual growth rate of noncystic VS. The results of this study provide data on cystic VS attenuation demonstrated by CT or MRI which may be valuable in neuroradiological diagnosis of these cystic lesions and emphasizes that the wait-and-see policy should not be applied to the cystic variant of VS.

Adult↗