RESUMEN
OBJECTIVE: To evaluate the significance of patients' ability to recognise symptoms that signify recurrence. METHODS: A retrospective analysis was conducted in Norway of demographic, clinical and follow-up data for patients with laryngeal carcinoma considered free of disease following treatment. The study included clinical data from 732 patients with glottic tumours and 249 patients with supraglottic tumours who were considered cured of disease. Data on the site, time and type of recurrence (symptomatic or asymptomatic) were retrieved. RESULTS: Recurrence was observed in 127 patients with glottic tumours and 71 with supraglottic tumours. A total of 103 glottic recurrences and 53 supraglottic recurrences were symptomatic. For patients with glottic carcinoma, recurrence detection through symptoms was associated with a favourable post-salvage survival rate compared with asymptomatic recurrences (p = 0.003). CONCLUSION: A patient's ability to self-detect 'red flag' symptoms and self-initiate visits represents a previously ignored prognostic factor, and may rationalise follow up and improve survival.
Asunto(s)
Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Recurrencia Local de Neoplasia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidad , Medios de Contraste , Bases de Datos Factuales , Supervivencia sin Enfermedad , Femenino , Hospitales Universitarios , Humanos , Estimación de Kaplan-Meier , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/mortalidad , Laringectomía/métodos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Noruega , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Terapia Recuperativa/métodos , Estadísticas no Paramétricas , Análisis de Supervivencia , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Since 1995 patients with T1a glottic carcinomas have been treated with laser surgery at the Department of Otorhinolaryngology, Rikshospitalet in Oslo. During this period we have in many cases noticed an inconsistency between the clinical outcome and the histopathological report describing that the resection margins were not free. We wanted to investigate this discrepancy, and the charts with the histopathological reports of 171 patients treated between 1995 and 2005 have been reviewed. Seventeen patients (10%) experienced a recurrence of the initial disease and were treated by repeated laser surgery, radiotherapy, or radiotherapy and laryngectomy. Two patients (1%) had died from the disease. In 36% of the cases (62 patients) the histopathological report indicated "not free" or "probably not free" resection margins. The discrepancy between the histopathological reports and the clinical outcome reflects the pathologist's difficulty in orienting and determining resection margins in laser-resected specimens. Because of the low number of recurrences or metastases, the verdict of a violated resection margin should probably not be crucial for further treatment. The surgeon's peroperative judgement may be trusted, however, with very close follow-up in order to detect early recurrences.
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Carcinoma/cirugía , Glotis/cirugía , Neoplasias Laríngeas/cirugía , Terapia por Láser/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/patología , Glotis/patología , Humanos , Neoplasias Laríngeas/patología , Persona de Mediana Edad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
The biocontrol yeast Pichia anomala J121 prevents mould growth during the storage of moist grain under low oxygen/high carbon dioxide conditions. Growth and metabolite formation of P. anomala was analyzed under two conditions of oxygen limitation: (a) initial aerobic conditions with restricted oxygen access during the growth period and (b) initial microaerobic conditions followed by anaerobiosis. Major intra- and extracellular metabolites were analyzed by high-resolution magic-angle spinning (HR-MAS) NMR and HPLC, respectively. HR-MAS NMR allows the analysis of major soluble compounds inside intact cells, without the need for an extraction step. Biomass production was higher in treatment (A), whereas the specific ethanol production rate during growth on glucose was similar in both treatments. This implies that oxygen availability affected the respiration and not the fermentation of the yeast. Following glucose depletion, ethanol was oxidized to acetate in treatment (A), but continued to be produced in (B). Arabitol accumulated in the culture substrate of both treatments, whereas glycerol only accumulated in treatment (B). Trehalose, arabitol, and glycerol accumulated inside the cells in both treatments. The levels of these metabolites were generally significantly higher in treatment (B) than in (A), indicating their importance for P. anomala during severe oxygen limitation/anaerobic conditions.
Asunto(s)
Oxígeno/metabolismo , Pichia/metabolismo , Acetatos/metabolismo , Aerobiosis , Anaerobiosis , Biomasa , Dióxido de Carbono/metabolismo , Cromatografía Líquida de Alta Presión , Etanol/metabolismo , Fermentación , Glucosa/metabolismo , Glicerol/metabolismo , Espectroscopía de Resonancia Magnética , Oxidación-Reducción , Consumo de Oxígeno , Pichia/química , Pichia/crecimiento & desarrollo , Alcoholes del Azúcar/metabolismo , Trehalosa/metabolismoRESUMEN
Osteoradionecrosis of the mandible is a serious complication following radiotherapy of head and neck cancers. A retrospective study of 20 reconstructions of mandibular defects due to osteoradionecrosis was performed. Various osseocutaneous free flaps were used: upper lateral arm (n = 5), radial forearm (n = 1), iliac crest (n = 4) and fibula (n = 7). Four grafts had a condylar prosthesis, and for seven grafts fixation was accomplished with a reconstruction plate. In three patients the mandibular defect was reconstructed using a bridging plate only. We defined a successful reconstruction as a graft or plate that did not need removal. Success was noted in 15 out of 20 patients, giving an overall success rate of 75%. For the free grafts alone (n = 17), successful reconstruction was achieved in 15 patients (88%). Two fibular grafts were lost owing to exposure and infection, as well as all three alloplastic reconstructions. Minor postoperative complications were observed in 11 patients (58%).
Asunto(s)
Enfermedades Mandibulares/cirugía , Osteorradionecrosis/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Femenino , Humanos , Técnicas de Fijación de Maxilares , Masculino , Microcirugia , Persona de Mediana Edad , Estudios Retrospectivos , Colgajos Quirúrgicos , Resultado del Tratamiento , Procedimientos Quirúrgicos VascularesRESUMEN
OBJECTIVES: To evaluate the health-related quality of life (HRQL) of patients with head and neck cancer during and after treatment with radiotherapy, surgery, and chemotherapy. STUDY DESIGN: Prospective, descriptive study. METHODS: All new patients in four institutions in Norway and Sweden were asked to participate. Health-related quality of life was assessed at baseline and at 1, 2, 3, 6, and 12 months after start of treatment by means of the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC head and neck cancer-specific questionnaire. Baseline results are described elsewhere; longitudinal results are presented in the current article. Three hundred fifty-seven patients with cancer in the oral cavity, pharynx, larynx, nose, sinuses, and salivary glands and neck node metastases from unknown primaries filled in the questionnaires at baseline. RESULTS: Seventy-eight percent of the patients who were alive after 12 months filled in all questionnaires (218/280). The general trend was that HRQL deteriorated significantly during treatment, followed by a slow recovery until the 12-month follow-up with few exceptions (senses, dry mouth, and sexuality). Patients who later died reported worse HRQL at each assessment point compared with patients who filled in all six questionnaires, whereas those who dropped out of the study for other reasons were quite similar to patients who filled in all questionnaires. The patients with pharyngeal cancer in general reported worse HRQL compared with the other groups and did not reach pretreatment values in several domains. Stage was also an important factor for HRQL in patients with head and neck cancer. CONCLUSION: Detailed knowledge about the differences between groups and changes over time may aid us in the communication with patients and in the design of intervention studies focusing on improvement of the support and rehabilitation of patients with head and neck cancer.
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Neoplasias de Cabeza y Cuello , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Neoplasias de Cabeza y Cuello/terapia , Humanos , Neoplasias Laríngeas , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Boca , Neoplasias Faríngeas , Estudios ProspectivosRESUMEN
BACKGROUND: The combination of T, N, and M classifications into stage groupings is meant to facilitate a number of activities, including the estimation of prognosis and the comparison of therapeutic interventions among similar groups of cases. We tested the UICC/AJCC 5th edition stage grouping and seven other TNM-based groupings proposed for head and neck cancer for their ability to meet these expectations in a specific site: carcinomas of the oral cavity. METHODS: We defined four criteria to assess each grouping scheme: (1) the subgroups defined by T, N, and M that make up a given group within a grouping scheme have similar survival rates (hazard consistency); (2) the survival rates differ among the groups (hazard discrimination); (3) the prediction of cure is high (outcome prediction); and (4) the distribution of patients among the groups is balanced. We identified or derived a measure for each criterion, and the findings were summarized by use of a scoring system. The range of scores was from 0 (best) to 7 (worst). The data are population based from a prospectively gathered series in Southern Norway, with 556 patients diagnosed from 1983 through 1995. Clinical stage assignment was used, and the outcome of interest was cause-specific survival. RESULTS: Summary scores across the eight schemes ranged from 1.66 for TANIS-3 to 6.50 for UICC/AJCC-5. The TANIS-7 staging scheme performed best on the hazard consistency criterion. The Kiricuta scheme performed best on the hazard discrimination criterion. Synderman predicted outcome best overall and Berg produced the most balanced distribution of cases among its groups. CONCLUSIONS: UICC/AJCC stage groupings were defined without empirical investigation. When tested, this scheme did not perform as well as any of seven empirically derived schemes we evaluated. Our results suggest that the usefulness of the TNM system could be enhanced by optimizing the design of stage groupings through empirical investigation.
Asunto(s)
Carcinoma de Células Escamosas/clasificación , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/clasificación , Neoplasias de la Boca/clasificación , Neoplasias de la Boca/patología , Estadificación de Neoplasias/clasificación , Carcinoma de Células Escamosas/mortalidad , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Reproducibilidad de los Resultados , Análisis de SupervivenciaRESUMEN
BACKGROUND: The craniofacial approach has greatly facilitated resections of tumours involving the base of the anterior cranial fossa when compared to either the transcranial or transfacial approach alone. MATERIAL AND METHODS: This approach was used in 11 patients with malignant tumours localized to the ethmoid sinus, orbit and bone or soft tissue of the base of the anterior part of the skull. By combining a low frontal or frontolateral craniotomy with resection of the facial skull, en bloc resections were accomplished. A frontogaleal periostal flap or a muscle flap from the temporal muscle was used to replace resected bone and to seal the skull base. RESULTS: There were no peri- or postoperative deaths. One patient died due to local recurrence, one patient is alive with residual tumour six years after surgery, and one is reoperated due to local recurrence. In addition one patient developed recurrence of a previously treated tumour of the maxillary sinus. Two patients developed meningitis and one pneumocephalus postoperatively. One patient has partial loss of vision and two patients underwent dacryocystorhinostomy due to epiphora. INTERPRETATION: The planning and execution of this type of surgery requires close interaction in an interdisciplinary team, in particular between neurosurgeon and head and neck surgeon.
Asunto(s)
Craneotomía/métodos , Neoplasias de la Base del Cráneo/cirugía , Base del Cráneo/cirugía , Neoplasias Craneales/cirugía , Adolescente , Adulto , Niño , Terapia Combinada , Hueso Etmoides/diagnóstico por imagen , Hueso Etmoides/patología , Hueso Etmoides/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Ilustración Médica , Persona de Mediana Edad , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Base del Cráneo/radioterapia , Neoplasias Craneales/patología , Neoplasias Craneales/radioterapia , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The skin areas that primarily drain into the parotid lymph nodes include large parts of the face, cheek, anterior surface of the auricle, temporal region, scalp and forehead. Malignant tumours, mainly squamous cell carcinomas and malignant melanomas, may therefore metastasis to the parotid gland. It may, however, sometimes be difficult to decide whether the parotid tumour is a primary or secondary tumour. MATERIAL AND METHODS: Twenty-six patients treated for metastatic malignant disease to the parotid gland were evaluated retrospectively. The mean age of the 22 males and four female patients was 70 years. RESULTS: In nine patients (35%), the primary tumour was ignored and wrongly interpreted as a tumour originating in the parotid gland. The primary tumour was localised in the temple in six patients, in the cheek in six, in the anterior surface of the outer ear in five, in the eyelids in four, in the forehead in one, in the scalp in one, and in the nasal vestibulum or nasal cavity in three patients. 19 patients (73%) had squamous cell carcinomas and seven (27%) malignant melanomas. The treatment was surgery supplied by radiotherapy in 19 patients. Four (21%) of the patients with squamous cell carcinoma and four (57%) of those with malignant melanoma died from the disease. INTERPRETATION: When a tumour arises in the parotid gland, the physician should critically evaluate whether this represents a secondary tumour. Careful examination of the scalp and face for suspect skin lesions and scars from extirpation of previous skin cancer can help detect the primary tumour.
Asunto(s)
Carcinoma de Células Escamosas/secundario , Neoplasias Faciales/patología , Melanoma/secundario , Neoplasias de la Parótida/secundario , Neoplasias Craneales/patología , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Melanoma/patología , Melanoma/cirugía , Persona de Mediana Edad , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/cirugía , Pronóstico , Estudios RetrospectivosRESUMEN
PURPOSE: A Swedish and Norwegian study was designed to examine health-related quality of life (HQL) in patients with head and neck cancer (head and neck) at diagnosis and during treatment and rehabilitation. The overall aim was to examine the impact on HQL at diagnosis depending on tumor location, stage, sex, and age (part I) and to describe HQL longitudinally and determine for which patients and during which period HQL deteriorated most (part II). This article presents the results at diagnosis. METHOD: Patients with head and neck cancer at five hospitals in Sweden and Norway were consecutively requested to participate. They were asked to answer the EORTC QLQ-C30 and QLQ-H&N35 (the European Organization for Research and Treatment of Cancer, Core 30 questionnaire and head and neck cancer module) repeatedly during 1 year. A total of 357 patients (mean age, 63 y; 72% males) were included. RESULTS: Patients with different tumor locations all had their special problems at diagnosis, for example, those with tumors in the larynx with communication, those with oral tumors with pain, and those with pharyngeal tumors with nutrition and pain. The patients with hypopharyngeal cancer reported the worst HQL. Stage appeared to have the strongest impact on HQL. Patients with a more advanced tumor stage reported significantly worse HQL scores for 24 of 32 variables reflecting functioning or problems. The females scored worse than the males for some areas, in particular, emotional functioning. The older patients scored significantly better for emotional and social functioning than patients <65 years but worse for physical functioning and various symptoms. The traditional way of grouping the tumor locations into oral, pharyngeal, laryngeal, and "other" tumors (salivary gland, sinus and nose, and unknown primary) was tested from a HQL point of view and found to be consistent. CONCLUSIONS: The chosen questionnaires differentiated between different sites of head and neck cancer at diagnosis. Tumor stage had the most powerful impact on HQL score.
Asunto(s)
Neoplasias de Cabeza y Cuello/psicología , Calidad de Vida , Anciano , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/epidemiología , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Noruega/epidemiología , Estudios Prospectivos , Encuestas y Cuestionarios , Suecia/epidemiologíaRESUMEN
We have retrospectively studied 73 patients with mandibular osteoradionecrosis (ORN) following radiotherapy (high voltage external beam radiation alone, or combined with brachytherapy) ranging from 50 to 130 Gy (mean 76) with fields including the mandible. Based on this analysis we defined four distinctive stages: Stage 0: mucosal defects only; Stage I: radiological evidence of necrotic bone with intact mucosa; Stage II: positive radiographic findings with denuded bone intra-orally; Stage III: clinically exposed radionecrotic bone, verified by imaging techniques, along with skin fistulas and infection. The clinical features and characteristics of these stages are described, along with their clinical courses and outcome. The incompleteness of current ORN definitions, mainly emphasizing mucosal defects and bone exposure, and the need for a revised ORN classification is pointed out. Based on these observations and the insufficiency of previous definitions, we arrived at the following ORN definition: Radiological evidence of bone necrosis within the radiation field, where tumour recurrence has been excluded.
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Enfermedades Mandibulares/diagnóstico por imagen , Osteorradionecrosis/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Enfermedades Mandibulares/patología , Enfermedades Mandibulares/cirugía , Persona de Mediana Edad , Osteorradionecrosis/patología , Osteorradionecrosis/cirugía , Radiografía , Dosificación Radioterapéutica , Estudios RetrospectivosRESUMEN
The Penicillium roqueforti group has recently been split into three species, P. roqueforti, Penicillium carneum, and Penicillium paneum, on the basis of differences in ribosomal DNA sequences and secondary metabolite profiles. We reevaluated the taxonomic identity of 52 livestock feed isolates from Sweden, previously identified by morphology as P. roqueforti, by comparing the sequences of the ribosomal internal transcribed spacer region. Identities were confirmed with random amplified polymorphic DNA analysis and secondary metabolite profiles. Of these isolates, 48 were P. roqueforti, 2 were P. paneum, and 2 were Penicillium expansum. No P. carneum isolates were found. The three species produce different mycotoxins, but no obvious relationship between mold and animal disease was detected, based on medical records. P. roqueforti appears to dominate in silage, but the ecological and toxicological importance of P. carneum and P. paneum as feed spoilage fungi is not clear. This is the first report of P. expansum in silage.
Asunto(s)
Alimentación Animal/microbiología , Penicillium/clasificación , Penicillium/genética , Animales , Bovinos , Medios de Cultivo , ADN de Hongos/análisis , Femenino , Microbiología de Alimentos , Mastitis Bovina/microbiología , Micosis/microbiología , Penicillium/aislamiento & purificación , Penicillium/metabolismo , Reacción en Cadena de la Polimerasa/métodos , Técnica del ADN Polimorfo Amplificado AleatorioRESUMEN
Several studies on oral squamous cell carcinomas (OSCC) suggest that the clinical value of traditional histologic grading is limited both by poor reproducibility and by low prognostic impact. However, the prognostic potential of a strictly quantitative and highly reproducible assessment of the tissue architecture in OSCC has not been evaluated. Using image analysis, in 193 cases of T1-2 (Stage I-II) OSCC we retrospectively investigated the prognostic impact of two graph theory-derived structural features: the average Delaunay Edge Length (DEL_av) and the average homogeneity of the Ulam Tree (ELH_av). Both structural features were derived from subgraphs of the Voronoi Diagram. The geometric centers of the cell nuclei were computed, generating a two-dimensional swarm of point-like seeds from which graphs could be constructed. The impact on survival of the computed values of ELH_av and DEL_av was estimated by the method of Kaplan and Meier, with relapse-free survival and overall survival as end-points. The prognostic values of DEL_av and ELH_av as computed for the invasive front, the superficial part of the carcinoma, the total carcinoma, and the normal-appearing oral mucosa were compared. For DEL_av, significant prognostic information was found in the invasive front (p < 0.001). No significant prognostic information was found in superficial part of the carcinoma (p = 0.34), in the carcinoma as a whole (p = 0.35), or in the normal-appearing mucosa (p = 0.27). For ELH_av, significant prognostic information was found in the invasive front (p = 0.01) and, surprisingly, in putatively normal mucosa (p = 0.03). No significant prognostic information was found in superficial parts of the carcinoma (p = 0.34) or in the total carcinoma (p = 0.11). In conclusion, strictly quantitative assessment of tissue architecture in the invasive front of OSCC yields highly prognostic information.
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Carcinoma de Células Escamosas/patología , Procesamiento de Imagen Asistido por Computador , Neoplasias de la Lengua/patología , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Leucoplasia/epidemiología , Masculino , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasia Residual/patología , Pronóstico , Reproducibilidad de los Resultados , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
A retrospective comparison of treatment policies in two institutions revealed a change in the reliance on radiotherapy. Since 1978, high-energy, high-dosage radiotherapy has played a prominent role in the primary therapy of squamous cell carcinoma of the supraglottic larynx. Statistically, the overall determinate survival rate has improved compared with results during the preceding period, but the death rate from intercurrent disease and second primary cancers has remained unchanged. Improved cancer control and patient survival were restricted to clinical tumor stages III, T4N0, and T4N1. The choice of primary therapy and the radiation dose and fractionation pattern were important variables influencing the survival. A description of the data is followed by a critical analysis of the significance of the findings, in view of the fact that the treatments were performed in two different institutions at different time periods.
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Carcinoma de Células Escamosas/mortalidad , Neoplasias Laríngeas/mortalidad , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Femenino , Glotis , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Dosificación RadioterapéuticaRESUMEN
OBJECTIVE: To investigate the prognostic significance of the carbohydrate epitopes H and Le(y) and their relationship with proliferation and apoptosis. STUDY DESIGN: Eighty randomly selected patients with T1-T4 oral tongue squamous cell carcinoma (SCC) were studied. Serial sections were cut from diagnostic, formalin-fixed, paraffin-embedded specimens. METHODS: Sections were stained immunohistochemically for H antigen and Le(y). RESULTS: Expression of H antigen was associated positively with Le(y) expression (P = .0001). Expressions of H antigen or Le(y) correlated with the proliferative markers Ki67 (P = .0442 and P = .0003, respectively) and pAgNOR > 1 (P = .0674 and P = .0047, respectively), but not with apoptotic markers such as Bax expression or the apoptotic index (AI). Tumors that expressed H antigen and high levels of Le(y) (> 50%) had a poor prognosis (P = .0006 and P = .0056, respectively). Combinations of expression of H antigen and Le(y), and either proliferative or apoptotic markers revealed an enhanced prognostic potential (P < .0001). The combination of pAgNOR score greater than 1 and H-antigen expression appeared to be the best combination to predict good prognosis. CONCLUSION: The expression of H antigen and Le(y), especially their combination with proliferative or apoptotic markers, has prognostic value in tongue SCC.
Asunto(s)
Sistema del Grupo Sanguíneo ABO/análisis , Carcinoma de Células Escamosas/sangre , Antígenos del Grupo Sanguíneo de Lewis/análisis , Neoplasias de la Lengua/sangre , Apoptosis , Biomarcadores de Tumor/análisis , Carcinoma de Células Escamosas/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Distribución Aleatoria , Neoplasias de la Lengua/epidemiologíaRESUMEN
BACKGROUND: Bax, Bcl-2, and p53 proteins are involved in the regulation of apoptosis and have been reported to correlate with prognosis in several tumor types. METHODS: Bax, Bcl-2, p53, and the level of spontaneous apoptosis were evaluated in formalin fixed, paraffin embedded pretreatment specimens from 85 T1-4 squamous cell carcinomas (SCCs) of the tongue by immunohistochemical methods. The percentage of apoptotic cells labeled by the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP labeling (TUNEL) method was expressed as an apoptotic index (AI). For Bax and Bcl-2 evaluation, the fraction of tumor cells stained and the staining intensities were given scores that were added together, resulting in a final score. p53 immunostaining was expressed as a percentage of positive cells. RESULTS: High AI was significantly associated with high Bax expression (P = 0.0122) and highly differentiated tumors (P = 0.0062). No correlation was found between AI and Bcl-2 expression. There was no correlation between p53 positivity and any of the other apoptosis-related parameters. Whereas low AI scores and low Bax expression correlated significantly with poor prognosis (P = 0.0053 and P = 0.0012, respectively), a low Bcl-2 expression was associated with a favorable clinical outcome (P = 0.0262). Patients with a high Bcl-2/Bax expression ratio had a significantly poorer prognosis than those with a low ratio (P < 0.0001). Multivariate analysis revealed that Bax expression, the Bcl-2/Bax expression ratio, and the T and N classifications were significantly independent prognostic variables. The Bcl-2/Bax expression ratio was the strongest independent prognostic parameter. CONCLUSIONS: AI, individual Bax and Bcl-2 expression, and particularly the Bcl-2/Bax expression ratio have prognostic value in SCC of the tongue.
Asunto(s)
Apoptosis , Carcinoma de Células Escamosas/patología , Proteínas Proto-Oncogénicas c-bcl-2/análisis , Proteínas Proto-Oncogénicas/análisis , Neoplasias de la Lengua/patología , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Carcinoma de Células Escamosas/metabolismo , Supervivencia sin Enfermedad , Femenino , Humanos , Inmunohistoquímica , Etiquetado Corte-Fin in Situ , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Coloración y Etiquetado , Neoplasias de la Lengua/metabolismo , Proteína p53 Supresora de Tumor/análisis , Proteína X Asociada a bcl-2RESUMEN
This study correlates static and flow-cytometric analysis on paraffin-embedded and fresh material of salivary gland carcinomas. Nuclear suspensions for DNA analysis were prepared from paraffin-embedded and fresh material. Comparison of the results of static and flow cytometry on paraffin-embedded material revealed no significant correlation between DNA ploidy and S-phase value. The coefficients of variation were significantly lower for static than for flow cytometry (p < 0.05). Flow-cytometric analysis on fresh and paraffin-embedded material correlated well concerning DNA ploidy, but not for the S-phase. The coefficients of variation were significantly lower for the fresh than for the paraffin-embedded material (p < 0.001). Cytometric analysis on paraffin-embedded material of malignant salivary gland carcinomas should be critically evaluated. There is a need for flow-cytometric investigations on fresh material to clarify further the prognostic value of this method.
Asunto(s)
ADN de Neoplasias/análisis , Neoplasias de las Glándulas Salivales/genética , Citometría de Flujo , Humanos , Adhesión en Parafina , Ploidias , Fase S , Glándulas Salivales/químicaRESUMEN
OBJECTIVE: To emphasize the integrated use of transcranial Doppler ultrasonography (TCD) in the management of internal carotid artery (ICA) closure. METHODS: Thirty-three patients being considered for ICA closure underwent TCD assessment, vasomotor reserve testing/estimation, and carotid artery test occlusion with concomitant middle cerebral artery (MCA) blood velocity (V(MCA)) monitoring, including calculation of the MCA pulsatility index. Twelve of these patients proceeded to undergo ICA sacrifice. Sequential TCD sonograms guided their postoperative treatment. RESULTS: ICA aneurysms and neck neoplasms affected the TCD results and vasomotor reserve insignificantly, whereas carotid-cavernous fistulae induced characteristic circulatory alterations. The 10 subjects who tolerated ICA sacrifice hemodynamically all showed an initial decrease in the ipsilateral V(MCA) to > or =60% of the preocclusion value and a progressively decreasing MCA pulsatility index during carotid artery test occlusion. The two patients who developed hemodynamic cerebral infarctions exhibited a decrease in V(MCA) to <60% and a MCA pulsatility index that remained stable after a vast initial reduction. Postoperative hypervolemic and hypertensive support was safely titrated in all patients who received postoperative TCD surveillance, providing an ipsilateral V(MCA) of > or =80% of the preocclusion value. ICA closure permanently altered the cerebral circulatory pattern. CONCLUSION: The hemodynamic outcome of ICA sacrifice can be correctly predicted by using the TCD occlusion test. TCD provides the means to titrate the extent of postoperative hypervolemic/hypertensive support.
Asunto(s)
Arteria Carótida Interna/cirugía , Estenosis Carotídea/cirugía , Endoscopios , Ultrasonografía Doppler Transcraneal/instrumentación , Adolescente , Adulto , Anciano , Aneurisma/complicaciones , Aneurisma/diagnóstico por imagen , Aneurisma/cirugía , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/cirugía , Velocidad del Flujo Sanguíneo/fisiología , Encéfalo/irrigación sanguínea , Arteria Carótida Interna/diagnóstico por imagen , Seno Carotídeo/diagnóstico por imagen , Seno Carotídeo/cirugía , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/etiología , Niño , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Flujo Pulsátil/fisiologíaRESUMEN
A Swedish/Norwegian head and neck cancer study was designed to assess prospectively the levels of mental distress and psychiatric morbidity in a heterogeneous sample of newly diagnosed head and neck cancer patients. A total of 357 patients were included. The mean age was 63 years, and 72% were males. The patients were asked to answer the HAD scale (the Hospital Anxiety and Depression scale) six times during 1 year. The number of possible or probable cases of anxiety or depression disorder was calculated according to standardized cut-offs. Approximately one-third of the patients scored as a possible or probable case of a major mood disorder at each measurement point during the study year. There were new cases of anxiety or depression at each time point. The anxiety level was highest at diagnosis, while depression was most common during treatment. Females were more anxious than males at diagnosis, and patients under 65 years of age scored higher than those over 65. Patients with lower performance status and more advanced disease reported higher levels of mental distress and more often scored as a probable or possible cases of psychiatric disorder. Our psychometric analyses supported the two-dimensional structure and stability of the HAD scale. The HAD scale seems to be the method of choice for getting valid information about the probability of mood disorder in head and neck cancer populations. The prevalence of psychiatric morbidity found in this study emphasizes the importance of improved diagnosis and treatment.
Asunto(s)
Ansiedad/etiología , Depresión/etiología , Neoplasias de Cabeza y Cuello/psicología , Trastornos del Humor/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Depresión/epidemiología , Femenino , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Estudios Longitudinales , Masculino , Estado Civil , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Morbilidad , Cooperación del Paciente , Prevalencia , Estudios Prospectivos , Calidad de Vida , Encuestas y CuestionariosRESUMEN
PURPOSE: The aim of this study was to define the scales and test the validity, reliability, and sensitivity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-H&N35, a questionnaire designed to assess the quality of life of head and neck (H&N) cancer patients in conjunction with the general cancer-specific EORTC QLQ-C30. PATIENTS AND METHODS: Questionnaires were given to 500 H&N cancer patients from Norway, Sweden, and the Netherlands as part of two prospective studies. The patients completed the questionnaires before, during (Norway and Sweden only), and after treatment, yielding a total of 2070 completed questionnaires. RESULTS: The compliance rate was high, and the questionnaires were well accepted by the patients. Seven scales were constructed (pain, swallowing, senses, speech, social eating, social contact, sexuality). Scales and single items were sensitive to differences between patient subgroups with relation to site, stage, or performance status. Most scales and single items were sensitive to changes, with differences of various magnitudes according to the site in question. The internal consistency, as assessed by Cronbach's alpha coefficient, varied according to assessment point and within subsamples of patients. A low overall alpha value was found for the speech and the senses scales, but values were higher in assessments of patients with laryngeal cancer and in patients with nose, sinus, and salivary gland tumors. Scales and single items in the QLQ-H&N35 seem to be more sensitive to differences between groups and changes over time than do the scales and single items in the core questionnaire. CONCLUSION: The QLQ-H&N35, in conjunction with the QLQ-C30, provides a valuable tool for the assessment of health-related quality of life in clinical studies of H&N cancer patients before, during, and after treatment with radiotherapy, surgery, or chemotherapy.