Biomedical subjects

S P Stringer

Publications and source records attributed to S P Stringer.

At least 37 records · Page 2Linked to original sources

PubMed1998

Carcinoma of the skin metastatic to the parotid area lymph nodes.

BACKGROUND: We performed an analysis of treatment outcome at the University of Florida for 77 patients with previously untreated carcinoma of the skin metastatic to parotid area lymph nodes. METHODS: Seventy-seven patients with 79 parotid node metastases were treated with curative intent between 1966 and 1994. All patients had a minimum 2-year follow-up. Treatment consisted of radiotherapy alone in 18 patients, preoperative radiotherapy in 6 patients (7 parotids), and postoperative radiotherapy in 53 patients (54 parotids). RESULTS: Overall rate of disease control in the parotid area at 5 years was 82%. Parotid area disease control according to treatment group revealed: surgery and postoperative radiotherapy, 43 of 48 (90%); preoperative radiotherapy and surgery, 4 of 5 (80%); and radiotherapy alone, 8 of 15 (53%). Multivariate analysis of parotid disease control revealed the following: treatment method (p = .0037), N stage (p = .0726), cranial nerve involvement (p = .1851), fixation (p = .1820), skin involvement (p = .1771), and sex (p = .5782). Overall 5-year absolute and cause-specific survival rates were 54% and 68%, respectively. The 5-year cause-specific survival rate was 72% after surgery and postoperative radiotherapy and 59% following radiotherapy alone. Multivariate analysis of cause-specific survival revealed the following: skin involvement (p = .0215), cranial nerve involvement (p = .1549), fixation (p = .0347), N stage (p = .4302), sex (p = .6806), and treatment method (p = .9599). CONCLUSIONS: Our current policy is to treat patients with tumor that is initially resectable with surgery followed by radiotherapy, whereas those who have initially unresectable disease undergo preoperative radiotherapy followed by surgical resection if the tumor becomes resectable. If surgery cannot be performed for medical reasons, patients still have better than a 50% chance of being cured with radiotherapy alone.

Adult↗

PubMed1998

Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site.

BACKGROUND: The purpose of this study was to evaluate the efficacy of the modern diagnostic evaluation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. METHODS: One hundred thirty patients were evaluated between June 1983 and June 1997. All underwent head and neck examinations, head and neck computed tomography (CT), and/or magnetic resonance imaging (MRI) scans, panendoscopies, and biopsies of head and neck mucosal sites. Twenty-four patients underwent 2-[fluorine-18]-2-deoxy-D-glucose (FDG) single photon emission computed tomography (SPECT); 34 patients underwent tonsillectomy. RESULTS: The primary site was identified in 56 patients (43%); the likelihood was increased in patients with suggestive findings on physical examination and/or radiographic evaluation. Eighty-three percent of the lesions were located in the tonsillar fossa and base of tongue. Results of FDG-SPECT scans were positive in 20 patients (83%); the primary tumor was detected in 7 patients (35%). Twelve (35%) of 34 patients who underwent tonsillectomy had a primary tumor discovered in the tonsillar fossa. Multivariate analysis of successful primary site detection revealed that suggestive findings on physical examination (p= .0225) and suggestive findings on CT and/or MRI (p = .0013) were significantly related to this end point. CONCLUSION: The primary lesion will be detected in over 40% of patients with physical examination of the head and neck and CT and/or MRI followed by panendoscopy and biopsies. Limited data pertaining to FDG-SPECT suggest that this provides additional useful information in a small subset of patients. Tonsillectomy is useful for those with suggestive findings on physical examination and/or radiographic evaluation.

Adult↗

PubMed1998

Analysis of protease activity in human otitis media.

Chronic otitis media is a common problem associated with a nonintact tympanic membrane frequently involving Staphylococcus aureus and Pseudomonas aeruginosa. The virulence of Pseudomonas bacteria is related to the production of two matrix metalloproteinases, elastase and alkaline protease. Serine proteases, such as neutrophil elastase, are produced by the host inflammatory response. These proteases are thought to contribute to tissue destruction and assist bacterial invasion during infection. This preliminary study was done to identify protease activity in otorrhea samples from patients with otitis media and a nonintact tympanic membrane and to examine the ability of selective protease inhibitors to decrease protease activity. Ilomostat (galardin) is a synthetic, specific inhibitor of matrix metalloproteinases including P. aeruginosa elastase and alkaline protease, whereas alpha1-antitrypsin inhibits serine proteases including neutrophil elastase. Samples were collected and cultured from 20 patients with otorrhea resulting from tympanic membrane perforations or pressure-equalization tubes. A protease assay that used azocasein as the substrate was used to quantify protease activity, with and without addition of selective protease inhibitors. Cultures revealed P. aeruginosa alone in 7 samples, P. aeruginosa plus other organisms in 10, and S. aureus alone in 3. Protease activity was detected in 15 (75%) of the samples. A statistically significant (p < 0.05) decrease in protease activity was seen with the addition of alpha1-antitrypsin or Ilomostat plus alpha1-antitrypsin, but not with Ilomostat alone. Analyzing the 10 samples with the highest protease activity, a statistically significant decrease in activity was seen with Ilomostat or alpha1-antitrypsin alone and with both Ilomostat and alpha1-antitrypsin together. Bacteriologic type, source of sample, age and gender of the subject, and duration of infection were not significantly related to protease activity. This is the first study to quantify protease activity and inhibition by selective protease inhibitors in human otorrhea. Protease inhibitors effectively decrease protease activity in most cases and in addition to standard antibiotic therapy might prove beneficial in the treatment of otitis media with a nonintact tympanic membrane. This study supports future clinical investigations into the role of proteases and inhibition of protease activity in the treatment of otitis media.

Anti-Bacterial Agents↗

PubMed1997

An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity.

PURPOSE: To analyze factors influencing outcome in patients who received postoperative irradiation for advanced squamous cell carcinoma of the oral cavity. METHODS AND MATERIALS: Between October 1964 and November 1993, 134 patients with 135 previously untreated primary invasive squamous cell carcinomas of the oral cavity (excluding the lip) were treated postoperatively with continuous courses of external-beam irradiation at the University of Florida. All patients had a minimum follow-up of 2 years (analysis, December 1995). No patient was lost to follow-up. RESULTS: The 10-year actuarial rates of primary site, neck, and local-regional control were 79%, 88%, and 71%, respectively. Recurrence of cancer above the clavicles developed in 35 patients. Ninety-four percent of the recurrences were within the primary field of irradiation (anterior to the plane of the spinal cord); there were 24 recurrences at the primary site and nine in the upper neck alone. There were no failures in the neck area behind the plane of the spinal cord (i.e., the "posterior strip"). Two failures occurred in the low neck below the level of the thyroid notch. In univariate analyses, factors that affected local-regional control included pathologic stage (I-II vs. III-IV, p = 0.04), margin status (invasive cancer at the margin vs. other, p = 0.0007), multifocal tumor (p = 0.05), perineural invasion (p = 0.04), and number of indications for postoperative irradiation (p = 0.05). Extracapsular nodal extension was marginally significant (p = 0.07). In multivariate analysis, positive margins and number of indications remained significant. These factors were used to define relatively favorable (< 4 indications, margins not positive) and unfavorable (> or = 4 indications and/or margins positive for invasive cancer) groups. For both favorable and unfavorable groups, there were nonsignificant trends toward improved local-regional control for patients who began irradiation within 45-50 days, compared with those whose irradiation began later. There were also nonsignificant trends toward improved control for patients treated with shorter overall irradiation treatment courses. An analysis was also performed on the effects of duration of the overall "treatment package" (from the date of surgery until the last day of irradiation). For patients with unfavorable tumors, there was a significantly higher probability of local-regional control for patients whose overall "treatment package" was < or = 100 days (60% vs. 14%, p = 0.04). The 5-year rate of distant metastasis as the sole site of failure was 8% and was predicted by pathologic N stage (N0-N1, 3%; N2-N3, 16%, p = 0.02), as well as the presence (20%) or absence (6%) of extracapsular nodal extension (p = 0.06). The 5-year freedom-from-relapse rate was 63%. The 5-year survival and cause-specific survival rates were 50% and 67%, respectively. Four severe radiation injuries occurred (3%). CONCLUSION: This paper provides data that define relatively favorable and unfavorable groups of patients in the postoperative setting. Patients with four or more indications for irradiation and/or invasive cancer at the surgical margins have a worse outcome than patients who do not have these negative factors; this is true in spite of the fact that the unfavorable group received higher doses of radiation. Attention should be focused on not only the interval between surgery and irradiation, but also time-dose parameters and the overall duration of the treatment "package."

Adolescent↗

PubMed1997

Vascular leiomyoma of the superior turbinate: first reported case.

BACKGROUND: Vascular leiomyoma is an uncommon smooth muscle tumor rarely found in the head and neck area. We report the first case arising for the superior turbinate of the nasal cavity. METHODS: A case presentation, treatment, and review of the literature are discussed. RESULTS: Twenty-one months after embolization and surgical resection, the patient is doing well, without evidence or recurrence. CONCLUSIONS: Vascular leiomyoma is a rare benign tumor of the nasal cavity, and surgical excision yields high cure rates.

Adult↗

PubMed1997

Definitive radiotherapy for T3 squamous cell carcinoma of the glottic larynx.

PURPOSE: To report the results of radiotherapy alone for stage T3 squamous cell carcinoma of the true vocal cord and compare these data with those obtained with other treatment modalities. METHODS AND MATERIALS: Seventy-five patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated with curative intent with radiotherapy alone (73 patients) or followed by a planned neck dissection (two patients) at the University of Florida between September 1966 and August 1994. No patient received adjuvant chemotherapy. All patients were monitored for at least 2 years and 85% had a minimum follow-up duration of 5 years. No patient was lost to follow-up evaluation. RESULTS: The 5-year local control and ultimate local control rates were 63% and 86%, respectively. The volume of the primary tumor (which was calculated on pretreatment computed tomographic [CT] scans in 38 patients) was inversely related to local control with larynx preservation: < or = 3.5 cm3, 20 of 23 (87%) versus greater than 3.5 cm3, four of 14 (29%) (P = .0005). There was no apparent relationship between local control after radiotherapy as a function of whether the vocal cord regained mobility or remained fixed during or shortly after completion of treatment. The 5-year absolute and cause-specific survival rates were 54% and 78%, respectively. Multivariate analysis showed that pretreatment tracheostomy was significantly related to diminished cause-specific survival (P = .0345). CONCLUSION: Radiotherapy alone results in long-term local-regional control and survival rates that are comparable to those obtained with surgery. It is unclear whether induction or concomitant chemotherapy is associated with improved local-regional control and survival compared with radiotherapy alone.

Carcinoma, Squamous Cell↗

PubMed1997

Radiotherapy for carcinoma of the supraglottis.

Squamous cell carcinoma of the supraglottic larynx is treated primarily by conservation surgery or radiotherapy for early to moderately advanced lesions, and total laryngectomy, with or without irradiation, for advanced tumors. This article reviews the role of radiotherapy, used alone or in combination with surgery, for squamous cell carcinoma of the supraglottic larynx. Treatment philosophy, techniques, and results from the University of Florida are emphasized.

Carcinoma, Squamous Cell↗

PubMed1996

Management of minor salivary gland carcinomas.

PURPOSE: To assess the role of radiotherapy alone or in combination with surgery in the treatment of patients with malignant minor salivary gland carcinomas. METHODS AND MATERIALS: Between October 1964 and November 1992, 95 patients with minor salivary gland carcinomas of the head and neck received radiotherapy with curative intent. Eighty-seven patients were previously untreated, and 8 were treated for postsurgical recurrence. Fifty-one patients were treated with radiotherapy alone, and 44 were treated by surgical resection plus radiotherapy. Patients were staged according to the 1983 American Joint Committee on Cancer (AJCC) staging criteria for squamous cell carcinomas. RESULTS: The 20-year actuarial rate of local control was 57% with no significant difference according to histologic type. When tumor stage was taken into consideration, there were no significant differences in local control according to tumor site. The 12-year actuarial probability of distant metastases was 40% (19% as the only site of failure). In multivariate analyses, local control was significantly affected only by tumor stage and treatment type (combined therapy better than radiotherapy alone); tumor stage was a significant predictor of cause-specific survival and freedom from relapse. Freedom-from-relapse rates were higher for patients who received combined treatment (p = 0.068). CONCLUSIONS: Treatment of minor salivary gland carcinomas is usually by combined surgery and radiotherapy, but there are situations where surgery alone or radiotherapy alone may be used. The ability to control these tumors with radiotherapy alone is not widely recognized. In the present series, the tumor was locally controlled in 20 patients with previously untreated primary lesions after radiotherapy alone (2.5 to 21 years) and in 4 other patients who were treated by radiotherapy alone for postsurgical recurrent tumor (3.5 to 14 years after radiotherapy). Contrary to the widely held belief that local recurrence after radiotherapy eventually develops in all patients with adenoid cystic carcinoma, local control has been maintained in 13 patients after radiotherapy alone; 5 of the 13 patients have been observed for 10 to 17 years.

Adenocarcinoma↗

PubMed1996

Oropharyngeal carcinoma treated with radiotherapy: a 30-year experience.

PURPOSE: This study was done to determine the outcome in patients with oropharyngeal carcinoma treated at the University of Florida with radiotherapy alone to the primary site, for comparison with reported results of other types of treatment. METHODS AND MATERIALS: Of a consecutive cohort of 785 patients with biopsy-proven, previously untreated, invasive squamous cell carcinoma of the oropharynx, this report is based on the 490 patients who had continuous-course irradiation with curative intent at the University of Florida between October 1964 and January 1991. All patients had a minimum 2-year follow-up. Forty-eight percent had Stage T3 or T4 disease, and 64% had clinically apparent neck node metastases. The median radiation dose was 68 Gy for once-a-day treatment and 76.8 Gy for twice-a-day treatment. Patients with advanced neck node disease had planned neck dissection(s) after radiotherapy. RESULTS: The overall local control rate after radiotherapy alone was 73%. The ultimate local control rate (including surgical salvage) was 78%. At 5 years, the probability of control of neck disease was 85%; control above the clavicles, 67%; absolute survival, 44%; cause-specific survival, 77%; distant metastasis (as the first or only site of failure), 11%. Thirteen patients (2.6%) experienced severe treatment complications. CONCLUSION: Radiotherapy results in tumor control and survival rates comparable with rates achieved with combined irradiation and surgery, with less morbidity.

Carcinoma, Squamous Cell↗

PubMed1996

The effect of absorbable stenting on postoperative stenosis of the surgically enlarged maxillary sinus ostia in a rabbit animal model.

OBJECTIVE: To determine the effect of absorbable stenting on postoperative stenosis of the surgically enlarged maxillary sinus in a rabbit model. DESIGN: A randomized controlled animal study with each specimen serving as its own control. Animals had their maxillary ostia surgically enlarged bilaterally. Video images were made of each enlarged ostia. Unilateral stenting was performed using rolled absorbable stenting (Gelfilm, Upjohn Co, Kalamazoo, Mich). The animals were killed at 3 months and repeated images were made of each ostia. An image processing system (IBAS-AT, Kontron Instruments, Milan, Italy) was used to individually calibrate each image and then measure areas. Surgical and 3-month areas were compared with the examiner blinded to the stented side. SUBJECTS: Twelve specific pathogen-free New Zealand white rabbits. RESULTS: Stented ostia had an increased stenosis compared with unstented ostia, but this increase was not statistically significant (P = .08, Student t test). There was no within-animal change in nonstented ostia compared with an 18% decrease in the stented ostia. CONCLUSIONS: Stenting did not statistically change the amount of stenosis of the surgically enlarged ostia in a rabbit model, although a trend toward more scarring when compared with the nonstented side was observed.

Animals↗

PubMed1996

Inhibition of proteases in Pseudomonas otitis media in chinchillas.

The treatment of chronic suppurative otitis media caused by Pseudomonas aeruginosa remains a challenging problem. The virulence of Pseudomonas is related to its secretion of two matrix metalloproteinases, alkaline protease and elastase. This experiment examines the effects of a synthetic inhibitor of matrix metalloproteinases GM 6001, or N-(2(R)-2(hydroxyamido carbonylmethyl)-4-methylpentanoyl)-L-tryptophane methylamide), in a chinchilla Pseudomonas otitis media model. Thirty chinchillas underwent bilateral subtotal tympanic membrane perforations. Twenty-four chinchillas underwent bilateral middle ear inoculation with P. aeruginosa. Chinchillas were divided into four groups of six animals after the establishment of otitis media. Animals in one group were controls; the other three groups received either gentamicin, GM 6001, or gentamicin plus GM 6001 into the external auditory canal three times daily for 4 weeks. Clearance of Pseudomonas infection occurred in three ears of three animals, all in gentamicin groups, with or without GM 6001. Otorrhea (p = 0.0014) and external canal erythema (p = 0.025) were mild in the two gentamicin groups and moderate in the GM 6001 group when compared with bacterial controls. Animals in the GM 6001 group had the highest survival rate, less severe facial paralysis, and less vestibular toxicity than the gentamicin, gentamicin plus GM 6001, or control groups, although these differences were not statistically significant. This pilot study showed encouraging results for a role of ototopical protease inhibitors in the treatment of Pseudomonas otitis media.

Animals↗

PubMed1995

Salvage surgery following radiation failure in squamous cell carcinoma of the supraglottic larynx.

PURPOSE: We analyzed the clinical course of patients who developed local (primary) recurrence following high-dose irradiation of squamous cell carcinoma of the supraglottic larynx. METHODS AND MATERIALS: Between October 1964 and July 1991, 206 patients with previously untreated squamous cell carcinoma of the supraglottic larynx underwent radiotherapy with curative intent. Local failure occurred in 46 (22%) patients. Successful surgical salvage was defined as no evidence of recurrent cancer for at least 2 years after salvage surgery and continuously thereafter. RESULTS: Sixteen patients did not undergo salvage surgery because of refusal (7 patients), severe medical illness (2 patients), concurrent distant metastasis (5 patients), or unresectable neck disease (2 patients). Twenty-six patients underwent total laryngectomy, and 4 patients had a voice-sparing procedure. Successful salvage was achieved in 50% of patients who underwent surgery. The rate of successful salvage did not correlate with preirradiation T-stage or time to failure after irradiation. Most of the failures after surgery were because of failure to control the primary cancer. The overall rate of postsurgical complications was 37%. No operative or perioperative deaths occurred. The 5-year survival rate for all 46 patients, calculated from the date of irradiation failure, was 20%, while the 5-year survival rate after salvage surgery for the 30 patients who underwent the procedure was 29%. CONCLUSION: There are few data in the literature regarding the clinical outcome in patients whose tumors are not controlled by initial radiotherapy. In the current and previous series, one-half to two-thirds of patients who developed primary failure underwent salvage surgery, which was successful in approximately half of the operated patients, leading to a 25-30% rate of long-term disease-free survival among the entire group of patients who developed failure.

Adult↗

PubMed1995

Prophylactic antibiotic use in clean, uncontaminated neck dissection.

A recent report in the literature cites a 10% wound infection rate for clean, uncontaminated neck dissections in patients who did not receive antibiotic prophylaxis as compared with a 3.3% infection rate in patients who received prophylactic antibiotics. Although a trend favoring antibiotic prophylaxis was identified, the duration of therapy was not considered. The present analysis addresses this issue. The authors retrospectively reviewed the records of 120 patients who underwent clean, uncontaminated neck dissections over a 3-year period (July 1989 through May 1992) for variables related to wound infections. Radiation therapy had previously been used in 70% of these patients. Group 1 (31 patients) received 24 hours of perioperative antibiotic prophylaxis, and group 2 (89 patients) received antibiotic prophylaxis until the suction drains were removed (usually 4 or 5 days after surgery). No perioperative wound infections occurred in either group. The authors concluded that perioperative antibiotic prophylaxis for 24 hours is sufficient to prevent wound infections in clean, uncontaminated neck dissections.

Cefazolin↗

PubMed1995

Nasal mucociliary clearance after radiation therapy.

Irradiation has been demonstrated to cause decreased mucociliary clearance in animal models. We sought to verify this effect clinically by using the saccharin transport test to evaluate nasal mucociliary clearance in 9 patients previously treated with radiation therapy to the nasal cavity. The patients also completed a questionnaire examining the prevalence of nasal symptoms before and after radiation therapy. Patients who received radiation therapy had no clearance of saccharin from the nasal cavity at a minimum of 20 minutes. The controls had a median clearance time of 5 minutes. The patients noted a higher prevalence of nasal congestion, drainage, and facial pain after radiation therapy. This study demonstrates that radiation therapy to the nasal cavity causes a decrease in nasal mucociliary clearance. This alteration should be considered when selecting therapy for malignancies in the nasal area.

Administration, Intranasal↗

PubMed1995

Current concepts in surgical management of neck metastases from head and neck cancer.

The surgical management of neck metastases from head and neck cancer consists primarily of neck dissection. An awareness of both the cervical anatomy and natural history of squamous cell carcinoma of the upper aerodigestive tract is necessary to understand the role of neck dissection and to appreciate when it may be appropriate to modify the standard radical neck dissection. The use of imaging to augment palpation of the neck has resulted in greater accuracy in identifying neck metastases and has further clarified the role of modified neck dissections. Depending on the site and size of the primary tumor, radiation therapy, modified neck dissection, or selective neck dissection are all appropriate options for the elective treatment of the neck when there is a high risk of occult metastasis. Therapeutic neck dissection alone is adequate for early-stage neck disease, but must be combined with irradiation for more advanced stages. Regional control of tumor metastases is highly dependent on the stage of neck disease and the presence of extranodal cancer spread.

Head and Neck Neoplasms↗

PubMed1995

Radiation therapy for sinus malignancies.

Primary tumors arising in the nasal cavity and paranasal sinuses usually are considered together. Except in the nasal cavity, where occasional lesions present early because of nasal obstruction, most lesions are advanced at presentation, and the exact site of origin may be uncertain. Radiation therapy may be used alone or in combination with surgery in the management of patients with squamous cell carcinoma of these sites.

Aged↗

PubMed1994

Patency of the internal jugular vein following modified radical neck dissection.

Although the internal jugular vein is commonly preserved in modified radical neck dissections, the English literature contains only a single study assessing postoperative vein patency including only 13 patients. The present study was instituted to better determine the patency of the internal jugular vein following modified radical neck dissection and to identify factors associated with venous occlusion. Preoperative and postoperative computed tomography or magnetic resonance imaging was performed on 69 patients undergoing 79 vein sparing neck dissections. Sixty-eight veins (86%) were patent postoperatively. A retrospective chart review revealed that compression by either a musculocutaneous flap or recurrent carcinoma in the neck was associated with venous occlusion. We conclude that the internal jugular vein is likely to remain patent after modified radical neck dissection with vein preservation.

Combined Modality Therapy↗

PubMed1994

External beam irradiation alone or combined with neck dissection for base of tongue carcinoma: an alternative to primary surgery.

From 1964 to 1990, 134 patients were treated at the University of Florida with continuous-course external beam irradiation, alone or followed by a planned neck dissection, for T1 (n = 17), T2 (n = 47), T3 (n = 49), or T4 (n = 21) carcinoma of the base of tongue. The 5-year rate of local control was 90% for stage T1, 92% for T2, 73% for T3, and 35% for T4. Probability of control above the clavicles at 5 years according to modified American Joint Committee on Cancer (AJCC) stage was 100% for stages I and II, 75% for stage III, 84% for stage IVa, and 52% for stage IVb. Probability of relapse-free survival at 5 years was 100% for stages I and II, 68% for stage III, 81% for stage IVa, and 37% for stage IVb. Severe complications occurred in 2% of patients. Compared with surgical resection of the primary tumor, external beam radiotherapy results in similar rates of local control and survival with a lower risk of severe complications.

Adult↗