Biomedical subjects
Publications and source records attributed to A E Kortekangas.
We introduce a new sophisticated Finnish rhinomanometer in which the need for routine work has been minimized. Technical information about the instrument is given, recording procedure is described and a normal material and reproducibility test is analyzed.
Twenty-two patients with operable head and neck cancer were randomized to receive natural leukocyte alpha interferon (IFN) and radiotherapy, or radiotherapy alone (control) before operation. IFN was administered at 6 MU i.m. daily for 4 weeks and thereafter 3 times per week for 2 months. IFN treatment was introduced simultaneously with radiotherapy (2 Gy daily, 5 fractions per week). The preoperative dose was 30-32 Gy. Tumor response and side-effects were registered. The patients underwent radical surgery 3 weeks after the preoperative irradiation, followed by postoperative irradiation with 22-32 Gy. After preoperative treatment there were one complete response and 4 partial responses among 10 patients receiving IFN and 2 partial responses among 12 patients treated with irradiation alone. No difference in survival was demonstrated between the 2 groups. In the histologic examination of the surgical samples malignant cells were found in 6 of the IFN patients and in 8 of the control patients. The IFN patients had considerably more pronounced mucosal radiation reactions than the controls. The accrual of patients to the study was discontinued due to the side-effects.
190 cases of maxillary sinusitis with retention of secretions were treated by frequent irrigation through an irrigation tube inserted via inferior turbinate sinus. The technique of the tube insertion through a Lichtwitz needle is described. Repeated irrigations do not need any anaesthesia and are better approved by the patients than the usual puncture irrigation. The response seems to be at least equally good as has been observed in similar patient series by repeated puncture irrigations. The patients' requests of reinsertion of irrigation tube in cases of recurrencies gives addition support to the recommendation to accept such a therapy.
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Twenty-seven patients with operable squamous cell cancer of head and neck were randomized into the study. Twelve patients received Prospidin combined to preoperative radiotherapy and fourteen patients were treated with preoperative radiotherapy alone. The daily dose of the drug was from 0.70 mg/kg to 2 mg/kg and the total dose during preoperative radiotherapy was between 1800 mg and 2250 mg with a mean of 2073 mg. The recurrence rate was in patients receiving Prospidin three out of twelve and in patients treated with irradiation alone four out of fourteen during the observation time of 33 months. In the present study Prospidin combined with preoperative radiotherapy had no advantage as compared to irradiation alone.
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The response to radiation treatment was studied in 110 patients with head and neck cancer with a minimum follow-up of two years. If the tumour had disappeared by the mid-point of treatment (3000 rad), a significantly more favourable prognosis was found in early (T1-2N0) tumours. On the other hand, whether these tumours had disappeared or were persisting at the end of treatment, there was no difference in the recurrence during the observation time of two years. In advanced tumours there was no significant relationship between disappearance by the mid-point of treatment and recurrence up to two years. But when an advanced tumour had disappeared at the end of treatment, the prognosis was significantly more favourable. The unpredictability and often impossibility of judging the prognosis in individual cases encourages the authors to stress the importance of executing the original individual surgical plan irrespective of radiation response.
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Middle-ear ventilation tubes (of the Sheehy modification) were placed in 401 ears of 209 children under 16 years of age as treatment for recurrent middle-ear infection. The same procedure was later required in 26% of the cases studied because of further recurrence of middle-ear infection. In four per cent of all patients studied, the ventilating tube failed to cure middle ear disease in spite of controlled concomitant antibacterial therapy. In these cases, an early extrusion of the tube was commonly found. Among all patients, the tube was spontaneously extruded in 76 per cent of the ears, whereas the intubation time was longer than half a year in 53 per cent of the cases. No complications from insertion of the ventilation tubes was seen in the present series of patients. The tympanic membrane was found to be normal in 71 per cent of all cases when follow-up examination was obtained three months after completion in intubation. However, a permanent tympanic membrane perforation was found in five ears (1% of patients). The present study has confirmed the usefulness of middle-ear ventilation tubes, particularly in patients with recurrent middle-ear infections.
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The usefulness of nasopharyngeal-antral pressure difference recording as a part of clinical ostial patency testing is demonstrated by statistical calculations from 507 patency tests. This method offers a quick confirmation of the comparison of pressure variation measured by anterior rhinomanometry and by antral pressure recordings which are the main elements of a consecutive patency test. In addition, the nasopharyngeal-antral recording has many of the advantages of a simultaneous patency test. When this difference recording is applied, the nasal reference pressure recording can also be omitted without any loss of information sought by the patency test.
Experience with 47 patients with head and neck carcinoma operated after preoperative megavoltage irradiation of about 3 000 rads over 3 weeks is reported. The 3-year survival for the series was 25/47 (53%), for the cases of Stages I--II 13/19 (68%) and Stages III--IV 12/28 (43%). Neoplastic cells could not be detected in 18% of the cases at operative biopsy. The remaining neoplastic cells were considered to be degenerated and non-vital in 14%, but in 68% of the cases the histological examination revealed a viable neoplasm. Changes in the macroscopic appearance did not correlate very well with the histological findings. Disadvantages of the irradiation were so minimal that the authors consider the general application of preoperative radiation in the therapy of head and neck malignancies to be the treatment of choice.