Biomedical subjects

B M Lippert

Publications and source records attributed to B M Lippert.

At least 19 recordsLinked to original sources

PubMed1998

Long-term results after laser turbinectomy.

BACKGROUND AND OBJECTIVE: Different types of lasers have been used for reduction of hypertrophic inferior turbinates in recent years with good results. Reports about the long-term benefits of the laser treatment are rare. STUDY DESIGN/MATERIALS AND METHODS: At the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, from April 1987 to March 1997, 658 patients with nasal obstruction caused by hypertrophic inferior turbinates were treated with the CO2 or Nd:YAG laser. Of these patients, 118 were able to be followed for a period of 5 years. RESULTS: After 5 years, 54 of 70 patients (77.1%) treated with the CO2 laser were satisfied. The success rate after Nd:YAG laser surgery was 64.6% (31/48 patients). Severe intra- or postoperative complications were not observed. CONCLUSION: The results suggest that the CO2 and Nd:YAG laser surgical techniques are suitable for the treatment of hypertrophic inferior turbinates. The main advantages are the decreased bleeding risk and the fact that the operation can be conducted as an outpatient procedure.

Follow-Up Studies↗

PubMed1998

[Clinical and molecular biology studies of laryngeal papillomatosis].

BACKGROUND: Recurrent laryngeal papillomatosis is a benign neoplastic disease which is probably caused by but at least associated with the Human Papilloma Virus. It can be of significant importance for the affected patients because of its recurrent clinical course. A wide variety of therapeutic measures have been described including the surgical removal either with conventional instruments or laser. Malignancies developing from papillomas have been reported. PATIENTS: The clinical courses of all 95 patients who have been treated for laryngeal papillomatosis since 1960 were analysed retrospectively. The two most common forms of treatment, surgical removal either conventionally or with the use of the laser, were compared. "Hot-start" polymerase chain reaction and Southern blot hybridization were used to detect HPV-DNA. The case reports of all patients developing cancer of the larynx are included. RESULTS: Laryngeal papillomatosis is a disease of all ages, more often first diagnosed before age 10 or after age 30. Puberty had no effect on the clinical course. However, the rate of complications such as tracheostomy and glottic webs was significantly reduced after laser surgery. HPV-DNA was found in 10 of 11 samples. Squamous cell carcinoma subsequently developed in four cases, three of which occurred almost simultaneously and were therefore not included. CONCLUSION: The term juvenile laryngeal papillomatosis should be replaced by recurrent respiratory papillomatosis. The occurrence of squamous cell carcinomas in patients previously treated for papillomas underlines the need for repeated histological studies. The surgical treatment remains the mainstay in the management of laryngeal papillomatosis. The laser surgical technique is superior to conventional removal. Using the most sensitive and specific methods presently available, HPV-DNA can be detected in a large percentage of laryngeal papillomas.

Adolescent↗

PubMed1998

[Re-amplification of differentially expressed mRNA fragments of head-neck cancers without cloning].

BACKGROUND: mRNA expression of healthy and malignant cells can be compared to each other by employing the "differential display" (DD) technique. Most studies describe sequence analysis of differentially expressed fragments after reamplification by a second round of PCR and subsequent molecular cloning to gain a sufficient amount of DNA for sequencing. The aim of this study was to show whether a sufficient amount of differentially expressed mRNA of squamous cell carcinoma cells of the head and neck region can be generated by PCR alone without cloning steps. MATERIAL AND METHODS: mRNA isolated from cultivated keratinocytes and squamous cell carcinoma cells was reverse transcribed into cDNA which was amplified with PCR. Differentially expressed fragments detected after gel electrophoresis were isolated from the gel and reamplified in a second PCR. The resulting cDNA amounts of the second PCR were suitable for cloning but not for direct sequencing. A third round of PCR with the undiluted final product of the second PCR as template regularly failed. Dilutions of the second PCR products between 1:10 and 1:10(10) were prepared. The third round of PCR was carried out with these various template concentrations. RESULTS: A sufficient amount of differentially expressed fragments for sequencing procedures resulted when dilutions of the second PCR products ranging from 1:10(2) to 1:10(7) were used as templates in the third round of PCR. CONCLUSION: Modifications of PCR parameters provide high DNA copy numbers of differentially expressed mRNA fragments from squamous cell carcinoma cells of the upper aerodigestive tract in amounts that are needed for sequence analysis. This may make it possible to avoid labor-intensive cloning procedures requiring high safety standards.

Base Sequence↗

PubMed1998

[Clinical and molecular biology studies of respiratory papillomatosis].

BACKGROUND: Recurrent laryngeal papillomatosis is a benign neoplastic disease which is probably caused by but at least associated with the human papillomavirus. It can be of significant importance for the affected patients because of its recurrent clinical course. A great variety of therapeutic measures has been described including the surgical removal either with conventional instruments or using the laser. Development of malignancies from papillomas have been reported. PATIENTS: The clinical courses of all 95 patients who have been treated for laryngeal papillomatosis since 1960 were analysed retrospectively. The two most common forms of treatment, surgical removal either conventionally or with the use of the laser, were compared. "Hot start" polymerase chain reaction and Southern blot hybridization were used to detect HPV DNA. The case reports of all patients developing cancer of the larynx are included. RESULTS: Laryngeal papillomatosis is a disease of all ages, more often first diagnosed in the first and fourth decade. Puberty had no effect on the clinical course. The different forms of treatment did not affect the rate of recurrence. However, the rate of complications such as tracheostomy and glottic webs was significantly reduced after laser surgery. Since the introduction of this new form of therapy no more tracheostomies had to be performed on these patients. HPV DNA was found in four of five samples (HPV 6:3, HPV 11:1). Squamous cell carcinoma subsequently developed in four cases, three of which occurred almost simultaneously and were therefore not included. CONCLUSION: The term juvenile laryngeal papillomatosis should be replaced by recurrent respiratory papillomatosis. One could then distinguish according to the age of onset, i.e., in children below the age of 16 years and in adolescents and adults older than 15 years. The occurrence of squamous cell carcinomas in patients previously treated for papillomas underlines the need for repeated histological studies. The surgical treatment remains the mainstay in the management of laryngeal papillomatosis. The laser surgical technique is superior to conventional removal. Using the at present most sensitive and specific methods HPV DNA can be detected in a large percentage of laryngeal papillomas.

Adolescent↗

PubMed1998

[Primary mucous membrane melanoma of the base of the tongue].

BACKGROUND: Primary mucosal melanoma of the tongue is an absolute rarity. A review of the literature revealed only 28 cases. PATIENT: The following report deals with an 87-year-old male patient who developed a primary melanoma of the left base of his tongue. The melanoma was excised with the CO2 laser. The patient refused surgical removal of the lymph nodes as well as radiation therapy. RESULTS: The laser resection of the melanoma led to a local control of the tumor at its primary site until the patient died from a stroke 30 months after the initial diagnosis. CONCLUSION: Limited melanoma of the mucosa of the tongue can be excised with the CO2 laser, if the resection can be performed with margins of healthy tissue as large as those in conventional surgery. Surgical therapy with primary palliative intention seems also to be adequate as relief of local symptoms can be achieved even for a longer period of time.

Aged↗

PubMed1998

Prevalence of human papillomavirus in squamous cell carcinoma of the head and neck determined by polymerase chain reaction and Southern blot hybridization: proposal for optimized diagnostic requirements.

Human papillomaviruses (HPV) are discussed as cofactors in the carcinogenesis of squamous cell carcinoma of the head and neck (SCCHN). The prevalence of HPV infection in SCCHN is the subject of controversy since reported HPV prevalences range from less than 10% to almost 100%, depending mainly on the detection method employed. This study presents a realistic approximation to the real prevalence of HPV in SSCHN by applying polymerase chain reaction (PCR) and Southern blot hybridization (SBH), which are the most sensitive and specific HPV detection methods. Diagnostic procedures were optimized by applying a "hot-start" PCR protocol followed by a confirmatory SBH of the PCR products to reactions using both type-specific and consensus primers and probes. DNA of 75 tumour samples and 22 normal mucosa samples of the same patients were investigated. In 14 cases genomic SBH using complete HPV genomes as probes was performed additionally. HPV DNA was detected in 17/75 (22.7%) SCCHN specimens. HPV 16 was identified in four cases, HPV 45 in three cases, and HPV 6 and 18 in one case each. Hot-start PCR and SBH are the most reliable HPV detection methods, as they minimize both false-positive and false-negative results. With these methods, a HPV prevalence of 23% was achieved, which can be assumed to be representative for comparable study populations. The significant number of positives detected only by consensus primer PCR, along with the identification of HPV 45, indicate that further HPV types may play an important role in the genesis of SCCHN.

Adult↗

PubMed1998

Ultrasound-guided interstitial Nd: YAG laser treatment of voluminous hemangiomas and vascular malformations in 92 patients.

In many cases voluminous vascular anomalies of the head and neck region are still treated with conventional surgery, although neodymium:yttrium-aluminum-garnet (Nd:YAG) laser therapy offers a valuable treatment alternative. Ninety-two patients with voluminous hemangiomas and vascular malformations were treated with interstitial Nd:YAG laser therapy (power density, 1300 to 3300 W/cm2), partly complemented by a noncontact-mode Nd:YAG laser light application (energy density, 1000 to 2500 J/cm2). The vascular tumors had a diameter of more than 3 cm in at least two dimensions. Treatment was carried out under ultrasound and manual control. Nearly 60% of the patients (n = 55) showed a complete clinical regression. Thirty-three patients (35.8%) had a partial regression and were satisfied with the treatment outcome. Four patients were treated unsuccessfully with the laser, and three of them subsequently underwent conventional surgery. Only nine of the 92 patients (9.8%) showed cosmetic or functional impairments. The results of this first consecutive series study with a retrospective clinical evaluation of the interstitial Nd:YAG laser therapy of voluminous hemangiomas and vascular malformations in a large patient group demonstrate a high effectiveness of this novel therapy modality.

Adolescent↗

PubMed1998

Differentially expressed genes in head and neck cancer.

Carcinogenesis is considered a multistep process. To further elucidate involved genetic changes, the differential display method was applied to compare gene expression of head and neck carcinoma cells and normal keratinocytes from the upper aerodigestive tract. Total RNA was extracted from cultured squamous carcinoma cells and keratinocytes. mRNA was reverse transcribed into cDNA, amplified by PCR, and separated on a gel. Currently three DNA transcripts were identified with a length of 191 to 336 base pairs (bp) that were either expressed only by the keratinocytes or by the malignant cells. Differentially expressed DNA fragments of the carcinoma cells and the keratinocytes were cloned and sequenced. A gene bank database search identified one fragment expressed by the carcinoma cells as an unknown gene, another one found in the keratinocytes as probably a part of the human cell attachment domain, and the third one with homology to the mRNA of the human epidermal growth factor receptor (EGFR). Northern blot analysis confirmed the differential expression in the malignant cells or the keratinocytes. Differential display seems to confirm the well-known overexpression and up-regulation of the EGFR, the differential expression of the cell attachment domain may play a role as a cofactor in carcinogenesis of head and neck cancer, and the third unknown fragment is still under investigation to elucidate the role in carcinogenesis.

Base Sequence↗

PubMed1998

Metalloproteinases and their inhibitors in squamous cell carcinoma of the hypopharynx: indicators of individual tumor aggressiveness.

BACKGROUND: Matrix metalloproteinases (MMP) are proteolytic enzymes capable of degrading connective tissue components. MMP activity is modulated by tissue inhibitors of metalloproteinases (TIMP). Imbalanced secretion of certain MMP or disturbances in the differential control of MMP by TIMP have been implicated in the invasive potential of malignant tumors. METHODS: Thirty-nine surgically obtained specimens of the hypopharynx were immunohistochemically stained with antibodies against MMP-1, MMP-2, MMP-3, MMP-9 and their inhibitors, TIMP-1 and TIMP-2. Thirty-one samples derived from primary tumors (PT-group) and 8 samples from recurrent tumors (RT-group). RESULTS: In the PT-group, MMP-1 was expressed in almost all tumors. Expression of TIMP-1 was rarer than of TIMP-2. Relapse occurred in 8/31 cases expressing MMP-1 or MMP-9 (4 cases each). Staining for TIMP-1 was negative in these patients, while TIMP-2 was expressed in most cases. In the RT-group, MMP-1 and MMP-9 stained positive in an almost equal number of cases. Only TIMP-1 was not expressed in any tumor. Patients who died of tumor were uniformly negative for TIMP-1. CONCLUSIONS: The findings suggest that the presence of MMP-9 and concomitant lack of TIMP-1 serve as prognostic indicators of tumor aggressiveness and increased risk of relapse.

Adult↗

PubMed1997

Microendoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser.

BACKGROUND AND OBJECTIVE: The hypopharyngeal (Zenker's) diverticulum is a herniation of mucosa and submucosa on the posterior wall of the pharynx. The only treatment is surgical. STUDY DESIGN/MATERIAL AND METHODS: Between 1976 and 1993, 109 patients with a hypopharyngeal diverticulum were operated on at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, either transcutaneously combined with a cricopharyngeal myotomy (n = 76), or microendoscopically (n = 37) using the CO2 laser. Results and complications of both techniques were evaluated and compared. RESULTS: With both surgical procedures, > 90% of the patients were treated successfully. The rate of postoperative complications was generally low. In comparison to the microendoscopic procedure, serious complications were found to be more frequent in patients treated with the conventional transcutaneous diverticulectomy. CONCLUSION: The laser surgical tissue bridge dissection is a less invasive, quick, relatively safe, and effective procedure requiring only short hospitalisation. Therefore, the laser surgical tissue bridge dissection can be considered as the method of choice for the treatment of the hypopharyngeal diverticulum.

Adult↗

PubMed1997

DNA ploidy and protein synthesis in squamous cell carcinoma cell lines of the head and neck.

Aneuploidy as abnormal nuclear DNA content, is considered almost positive evidence of malignancy. In this study three diploid and three aneuploid squamous cell carcinoma (SCC) cell lines were examined for DNA content by flow cytometry. The DNA indices of the SCC cell lines were found to range from 1.0 to 2.1. The mitotic activity of the diploid cell lines was 1.6 times higher and the cells were smaller than aneuploid cells. To find a molecular basis for these differences, the pattern of the de-novo synthesized proteins was analyzed by means of [35S]methionine incorporation, electrophoresis, and autoradiography. In all aneuploid SCC cell lines tested in this experiment, the increase of nuclear DNA content is associated with the synthesis of a novel protein with a molecular mass of approximate 55 kDa as well as with altered synthesis rates of two preexisting proteins (50 kDa and 100 kDa). For determination of the amino acid uptake in diploid and aneuploid cells, the accumulation of [35S]methionine was measured as a function of time by liquid scintillation counting. No significant difference was found in the uptake rate between diploid and aneuploid cells with the same protein content. However, discrepancies were revealed when equal numbers of cells with different DNA index were used, suggesting, that protein turnover is different in diploid and aneuploid SCC cells.

Aneuploidy↗

PubMed1997

Leiomyosarcoma of the larynx.

Leiomyosarcomas account for approximately 7% of all soft-tissue sarcomas and occur most frequently in the gastrointestinal tract and uterus. Leiomyosarcomas of the larynx are extremely rare with only about 27 cases reported in the available literature. We present a leiomyosarcoma of the left vocal cord that was treated by transoral CO2 laser surgery. To date, the patient has been free of disease for more than 25 months. Since these tumors may be difficult to diagnose, immunohistochemical studies may be necessary for making an unambiguous diagnosis. Primary treatment should be surgical resection, with small tumors suitable for partial laryngectomy or transoral laser surgery.

Humans↗

PubMed1997

[Treatment of recurrent epistaxis in Rendu-Osler-Weber disease].

Rendu-Osler-Weber disease is an autosomally dominant inherited disease which affects the connective tissue of blood vessels. The major symptom is recurrent epistaxis for which still exists no generally recommended treatment. Treatment modalities discussed in the literature include bilateral closure of the nostrils, brachytherapy, vessel embolization, hormone therapy, dermoplasties, as well as different kinds of laser therapies. Advantages and disadvantages of single treatment modalities are discussed. Dermoplasty and laser therapy seem to be the most suitable treatment procedures currently available for recurrent epistaxis in affected patients. Treatment carried out with the argon, KTP or ND:YAG laser has proven to be suitable as initial therapy. In most cases the additional use of long-term applications of a soft nasal ointment allows a lasting successful treatment. Our experiences show that dermoplasty should be reserved for cases with continued bleeding despite laser treatment but only rarely offers a long-term cure in the sense of a total recovery from epistaxis.

Aged↗

PubMed1997

p53 serum antibodies as prognostic indicator in head and neck cancer.

p53 antibodies are a new serological parameter of unknown potential in patients with malignancies. Their occurrence has been described in various types of cancer patients. The mechanism underlying the immunization process is still unclear. We investigated the incidence of p53 serum antibodies in 143 head and neck cancer patients with an enzyme-linked immunosorbent assay. The posttherapy course of two matched study groups (n = 38 each), one p53-antibody-seropositive and one p53-antibody-seronegative, was followed up for 24 months. Thirty-nine head and neck cancer patients (27.3%) were seropositive for p53 antibodies. During the follow-up, the p53-antibody-seropositive patients accounted for more local tumor recurrences (n = 12 versus n = 8) and more tumor-related deaths (n = 11 versus n = 5) than did seronegative patients, and second primary tumors (n = 9 versus n = 0) occurred exclusively in seropositive patients. In total, therapy failures (recurrences, tumor-related deaths, second primaries) were observed in 17/38 cases (44.7%) in the p53-antibody-seropositive group and in 8/38 cases (21.1%) in the p53-antibody-seronegative group. These results, after a follow-up of 2 years, seem to indicate a prognostic value of p53 serum antibodies for therapy failure in patients with head and neck cancer.

Adult↗

PubMed1997

[Chondrosarcoma of the larynx].

BACKGROUND: Manifestation of chondrosarcoma (CS) in the head and neck region is rare but it is the most frequently encountered non-epithelial malignancy of the larynx. Since this tumor entity is frequently neglected, its characteristics including differential diagnosis and therapy will be discussed in the following. PATIENTS: From 1975 to 1995, five cases with CS were diagnosed and treated in the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel. RESULTS: The medical history of this five patients (one woman, four men, average age: 71 years) varied from 9 months to 10 years. Three patients had a fixation of the vocal cord; one patient had obviously reduced movement of the vocal cord. Two cases revealed a moderate and three cases a high differentiation in the histological examination. Initially one case was diagnosed as a chondroma. The origin of tumor growth was the cricoid cartilage in four patients and the cartilage of the arytenoid in one patient. Surgical treatment was either by partial or complete laryngectomy in two cases each. One patient refused any therapy. Two patients including the latter died of tumor related causes. CONCLUSIONS: Laryngeal CS grow slowly. Diagnosis is frequently made late in the course of disease. Obtaining of tissue for histological examination and diagnostic delimitation towards a chondroma can be difficult. Therapy depends on the degree of histological differentiation with radical excision of low or moderately differentiated CS and function preserving surgery in case of high differentiation.

Aged↗

PubMed1997

[Reproducibility of nonradioactive DDRT-PCR method for detection of gene expression in squamous epithelial carcinoma cells of the upper aerodigestive tract].

BACKGROUND: The analysis of the gene spectrum in tumor and normal cells may provide information about genes involved in the differentiation or in the genesis of tumors. Differential Display Reverse Transcriptase Polymerase Chain Reaction (DDRT-PCR) is an innovative method that enables quick analysis of almost all mRNA molecules expressed in the cells. METHODS: In the trials, the mRNAs of keratinocytes and tumor cells were amplified by a number of oligonucleotide pairs after reverse transcription and resolved on polyacrylamide gel. A modified protocol for the amplification of cDNA probes was devised for detecting PCR products with silver nitrate. RESULTS: After reverse transcription of mRNAs, all cDNA samples were successfully amplified using the protocol devised for the silver nitrate DDRT-PCR, and the differentially expressed fragments were reproducibly demonstrated. CONCLUSIONS: The high reproducibility and feasibility of silver nitrate DDRT-PCR expand the alternatives for analyzing gene expression and detecting selectively expressed genes in different kinds of cells.

Carcinoma, Squamous Cell↗

PubMed1997

[Cultivation of human keratinocytes of mucous membranes of the upper aerodigestive tract].

BACKGROUND: Cultivation of benign epithelial cells under standardized conditions is of major interest in many fields of clinical and basic research. A modified fast and simple method for isolation, growth and passage of epidermal cells has been developed with consideration given to the complex environment of the upper aerodigestive tract. METHODS: Normal human mucosa of the upper aerodigestive tract was taken from 15 patients (4-73 years) during diagnostic and therapeutic operations. The epithelium could be separated easily from the mucosa after incubation the biopsies in disease over night. Subsequently, keratinocytes were isolated enzymatically by dissociation of epidermal sheets in trypsin, resulting a suspension of highly proliferating keratinocytes without contaminating fibroblasts (2 x 10(6) keratinocytes/biopsy). The cells were washed several times in fresh fetal calf serum before they were plated in untreated culture flasks. The keratinocytes were cultivated in serum-free medium supplemented with epidermal growth factor, bovine pituitary extract, amphotericin B, and penicillin/ streptomycin. RESULTS: An average plating efficiency of 60% in primary cultures and 85% in subcultures was obtained. Passaging was possible every 10-13 days when keratinocytes reached sufficient confluency. The cells could be subcultured up to eight times (lifespan of 120 days), and exhibited the typical epithelial morphology during cultivation. CONCLUSION: Because of the modified pretreatment of the keratinocytes before plating, this culturing protocol for keratinocytes derived from the upper aerodigestive tract enables easy and fast cultivation of keratinocytes, further simplifying currently available methods.

Adolescent↗

PubMed1997

[Mucous membrane melanomas of the upper aerodigestive tract. An analysis of 34 cases].

BACKGROUND: Malignant mucosal melanoma of the upper aerodigestive tract is a rare disease. The prognosis is expected to be significantly worse than the prognosis of cutaneous melanoma and so far no uniform therapeutic concept exists. Publications about mucosal melanoma are scarce and reported patient groups are usually small. PATIENTS: Thirty-four patients have been registered at the ENT Department of the University of Kiel Medical Center with the diagnosis mentioned above. Clinical data were obtained from the patient's charts, the minimum follow-up was three years. RESULTS: Most common site of the tumor was the nasal cavity and paranasal sinuses with 28 of 34 patients. Less frequently affected was the nasopharynx (three cases), oropharynx, larynx, and middle ear (one case each). All patients were caucasians and most of them were of an advanced age (66.9 years +/- 12.3). Treatment of choice was surgical resection in 27 cases, in four cases it was combined with radiation therapy, in one case with radiation therapy and chemotherapy, and in three cases with chemotherapy. Six patients received solely radiation therapy, one patient was only treated by chemotherapy. Patients who were treated by a combined approach had a more favourable outcome than patients who were treated by a monotherapy of surgery, radiation therapy, or chemotherapy. A high number of recurrences were observed, which occurred on an average of 16.6 months after the diagnosis of the primary tumor. Overall 5-year survival was 45.8%, the 10-year survival rate was 22.3%. CONCLUSIONS: Optimized combined therapeutical approaches might possibly improve the prognosis of mucosal melanoma of the upper aerodigestive tract. Intervals between follow-ups should be short to render detection of relapses at an early stage. Repeated therapy of recurrent disease might lengthen survival.

Combined Modality Therapy↗