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Biomedical subjects

C J Krause

Publications and source records attributed to C J Krause.

At least 19 recordsLinked to original sources
PubMed1992

Serial studies of autologous antibody reactivity to squamous cell carcinoma of the head and neck.

In previous studies we evaluated the incidence and specificity of autologous antibody reactivity against squamous cell carcinoma of the head and neck (SCCHN). We were able to demonstrate that autologous antibody reactivity is present in native sera but was usually of too low a titer to allow further analysis. Dissociation of immune complexes by acidification and ultrafiltration of serum augmented autologous antibody reactivity in nine out of nine autologous systems tested. Native antibody and antibody derived from immune complexes produced by the host and reactive with autologous tumor cells may be directed against physiologically relevant antigens. Therefore, correlations of antibody titers with clinical course may provide insight into the nature of the host response to cancer. In the present analysis, serological studies of six patients with SCCHN were performed with serum samples obtained over many months. Results of serial serological assays were correlated to tumor progression and clinical course. Fluctuations in autologous antibody reactivity were noted over time. In four cases, rises in autologous antibody titers preceded the clinical diagnosis of recurrence by several months. Drops in autologous antibody reactivity were noted in two cases following surgery or radiation therapy. In two cases of long-term survivors, no correlation between antibody reactivity and clinical course was noted. Specificity analysis of the six autologous systems demonstrated reactivity against autologous and allogeneic SCCHN as well as melanoma cell lines. These sera did not react with glioma, neuroblastoma, renal cell, breast, bladder and colon carcinoma cell lines nor with fetal calf serum, pooled lymphocytes, red blood cells and platelets. Autologous serial serological studies may provide a means by which to evaluate the host/tumor relationship in patients with SCCHN.

Aged↗
PubMed1979

Acinic cell carcinoma: a clinicopathologic study of thirty-five cases.

A clinicopathologic study of 35 cases of acinic cell carcinomas is presented. Complete follow-up information was available on 31 patients (average period, 7-5 years). The malignant potential of these neoplasms is affirmed by observations that metastases (local and distant) occurred in nine patients and that eight patients died as a consequence of their carcinoma. Retrospective classification of the carcinomas into high and low grade lesions correlated well with ultimate biologic behavior but is unlikely to be successful in an intra-operative (frozen section) mode. This limitation is due to: (a) sampling limitations at the time of primary surgery and (b) the malignant behavior of the occasional low grade carcinoma. Histologic features characterizing high grade carcinomas are local aggressive infiltration and areas of the tumor that appear analogous to the embryonic and post-embryonic terminal tubules and intercalated ducts. The best opportunity for cure of these neoplasms lies in their complete surgical removal at the time of initial treatment. For this, a total parotidectomy is the procedure of choice. Enucleation and local excision is to be condemned.

Adolescent↗
PubMed1979

Increased survival with surgery alone vs. combined therapy.

Recent investigations have questioned the efficacy of a combined therapy regimen with irradiation. The purpose of this study was to compare the survivals with surgery alone versus combined therapy (pre-op irradiation) and to analyze any apparent differences to identify the source(s) of failure. Two and five-year determinate survivals for this group identify the source(s) of failure. Two and five-year determinate survivals for this group were found to be significantly better for surgery alone. There is no instance where combination therapy is found to be statistically superior. An analysis of treatment failures showed that distant metastases occurred at a greater rate in the combined therapy patients than they did with those treated by surgery alone. The advisability of combined therapy using preoperative irradiation with its increased cost and morbidity to the patient is questioned if it does not improve survival over surgery used as a single modality.

Female↗
PubMed1979

Characteristics of tumor associated antigens in squamous cell carcinoma.

For centuries physicians have been intrigued by the variable biologic behavior of cancer in humans. In recent years, attention has focused upon the host immune response as an indicator of patient prognosis and for potential use in tumor detection. In this study, tumor associated antigens were extracted from fresh squamous cell carcinoma and their biologic properties were characterized. Using the Leukocyte Migration Inhibition (LMI) assay, considerable sharing of antigenic determinates was noted among the 12 carcinomas and 18 patients studied, though none cross-reacted with each of the others which were studied. Immune assays using pooled tumor extracts successfully differentiated between tumor patients and control subjects, though further development will be necessary before small aggregates of tumor may be consistently detected.

Adult↗
PubMed1978

Radiation effects on microvascular anastomosis.

Three groups of rats were studied. Group 1 rats received 6,000 R of irradiation, group 2 rats received 4,000 R, and group 3 rats acted as a control. Four weeks following irradiation, the femoral artery of each rat was cut and reapproximated using microvascular surgical techniques. Four weeks after surgery, the same femoral artery was evaluated for patency. There was no notable effect of irradiation on the patency of subsequently performed anastomosis of these small (1 mm in diameter) muscular arteries. Radiation effects were obvious on histological examination, but the anatomical and physiological alterations apparently were not severe enough to cause early thrombosis after microsurgical manipulation of these vessels.

Animals↗
PubMed1978

Cervicofacial actinomycosis. Rapid diagnosis by thin-needle aspiration.

Thin-needle aspiration cytology is a well-known minimally invasive technique that is used in the diagnosis of neoplastic disease. The same biopsy technique provides a means for immediate identification of actinomycosis. Aspiration specimens may be used for morphologic studies, as well as for microbiologic isolation. The diagnostic histologic feature of sulfur granules remains intact with this cytologic aspiration technique. This technique is a safe, simple, and rapid means of diagnosing actinomycosis and appears to have value in the diagnosis of other infectious diseases as well.

Actinomycosis, Cervicofacial↗
PubMed1978

Spinal accessory lymph nodes: a prospective study of metastatic involvement.

The traditional radical neck dissection involves excision of the spinal accessory nerve en bloc with the soft tissue of the posterior triangle in an effort ot remove completely all node-bearing tissue. The resultant decrease in range of motion of the involved extremity and subsequent pain have prompted some surgeons to seek alternatives. The purpose of this study is to review prospectively radical neck specimens with the specific intent of evaluating the frequency of metastatic involvement of the spinal accessory lymph nodes with head and neck malignancies. Fifty neck specimens were studied and the frequency of cancerous involvement of the spinal accessory nodes was not found to be significantly different from nodal involvement of the entire neck specimen. The location of accessory nerve involvement was predominantly in the proximal portion which is not within the posterior triangle. The results are further evaluated with the subsequent conclusion that preservation of the spinal accessory nerve cannot be justified on the basis of infrequent involvement with metastatic lymph nodes.

Accessory Nerve↗
PubMed1978

Cephalometric findings in two cases with unrepaired bilateral cleft lip and palate.

Two cases with unoperated bilateral cleft lip and palate were examined clinically and cephalometrically and compared to matched normals. The findings indicate a severe premaxillary skeletal protrusion which results in a maxillary-mandibular discrepancy. The maxillary incisor inclination was acceptable, while the mandibular incisors were relatively more lingually inclined in the cleft group. Surgical management of one case necessitated premaxillary resection.

Adolescent↗
PubMed1977

Irradiated homologous costal cartilate for facial contour restoration.

This study represents a retrospective evaluation of 145 implants of irradiated homologous costal cartilage used over a three-year period for facial contour restoration in a variety of anatomic sites. In this series, the immediate complication rate was 5.5%, the late complication rate was 2.1% and the partial resorption rate was 1.4%. The infection rate for the implants inserted intraorally onto the face of the maxilla did not have a statistically significant difference from the infection rate for the entire series, thus demonstrating that this implant is not easily infected. These results establish irradiated homologous costal cartilage as a valid implant material.

Adolescent↗
PubMed1977

The importance of tumor attachment to the carotid artery.

The records of 508 patients who had undergone radical neck dissection were reviewed. Twenty-eight of these patients (5.5%) were found to have tumor attached to the carotide arterial system. Twenty-four patients (86%) died with tumor, the mean survival time being 16.9 months. Local recurrence of tumor in the neck occurred in 46% of the patients and distant metastases in 67%. Eighteen percent of those who developed local recurrence did so in the absence of distant metastases and might have benefited from a more aggressive approach toward the tumor.

Adult↗
PubMed1977

Reconstruction of intraoral defects with the free groin flap.

A free flap has been defined as an island flap that has been completely detached from the body and transferred to a distant recipient site, where microvascular anastomoses are done to reestablish its essential intravascular circulation. The groin flap, based on its superficial circumflex iliac artery and venae comitantes, was utilized as a free flap to close large intraoral defects in six patients following ablative cancer operations. All patients received preoperative or postoperative irradiation therapy. Four of the six free groin flap operations were clinically successful. One flap became necrotic unexpectedly after 3 1/2 weeks. Infection played a major part in necrosis of the other flap. The use of the free flap in oral cavity reconstruction offers certain advantages over regional vascular flaps but definite limitations exist.

Adult↗
PubMed1977

DiGeorge syndrome associated with multiple squamous cell carcinomas.

Experimental evidence and clinical experiences have have shown that immune mechanisms and cancer are closely related. A case of a 42-year-old man with DiGeorge syndrome is presented as an interesting example of an impaired immune mechanism and is described in association with multiple squamous cell carcinomas of the upper respiratory system. The congenital absence of the thymus gland in DiGeorge syndrome results in an absence of a cell-mediated immune response. There are plasma cells and germinal centers in lymph nodes, but lymphocytes in the paracortical areas are sparse. Patients wiith DiGeorge syndrome have no delayed hypersensitivity, cannot be actively sensitized with dinitrochlorobenzene, reject allografts poorly, and have no lymphocytic response to phytohemagglutinin antigens.

Adult↗
PubMed1977

Carcinoma of the pyriform sinus a comparison of treatment modalities.

One hundred four patients with epidermoid carcinoma of the pyriform fossa were reviewed retrospectively. Survival, local recurrence and metastatic rates were all compiled for the purpose of comparing the efficacy of combined therapy with radiation therapy and surgery alone in treating such lesions. Combined therapy consisted of 4500 rad Cobalt60 therapy at 200 rad per day preoperatively. All lesions were staged according to AJC classification. There was a similar stage distribution of patients in each therapeutic category. Three-year determinate survival rates were as follows: radiation therapy --10%, surgery--56%, and combined therapy--40%. Evaluation of the local recurrence rate revealed it to be: radiation therapy--19/33 (58%), surgery--1/19 (5%), and combined therapy--9/32 (28%). We interpret this data to suggest that preoperative irradiation impaired the determination of adequate resection margins, despite the use of frozen sections from those margins at the time of surgery. The incidence of late contralateral palpable nodes was greatest in the surgery group--5/19 (26%), compared with radiation therapy--0/33, and combined therapy--1/32 (3%). This supports other studies which indicate that radiation therapy is very effective in controlling subclinical nodal metastases.

Carcinoma, Squamous Cell↗
PubMed1977

Microsurgical techniques in free flap reconstruction.

Free flap reconstruction is discussed with emphasis on microsurgical technique utilized in union of blood vessels 1 mm in external diameter. Proper microsurgical instrumentation, magnification and small vessel suture technique are all of importance in achieving a successful microvascular anastomosis. Technical maneuvers employed in identifying and avoiding small vessel thrombosis are presented. Surgical techniques, as presented here, have allowed us to successfully use free flaps to reconstruct large oral cavity defects following ablative cancer operations.

Blood Coagulation↗
PubMed1977

Fractures of the orbital floor.

The charts of 324 patients treated for 363 orbital floor fractures between 1965 and 1973 were reviewed retrospectively. Of these, 38 (11 percent) were isolated floor fractures, 27 (8 percent) were rim and floor fractures, 168 (46 percent) were trimalar fractures and 130 (35 percent) were associated with complex facial fractures. On initial examination, 31 percent of the patients were found to have diplopia and 4 percent enophthalmos. Orbital prolapse was suspected in 31 percent of the patients. Thirty-seven percent of the patients had demonstrable ocular injury at the time of initial examination. Treatment was surgical in 336 of the fractures and non-surgical in 29. Of the surgical patients 140 had no support placed, 120 had antral support only, 51 had both antral support and orbital implant, and 20 had an orbital implant only. Postoperatively the incidence of diplopia was 8 percent in all patients, and 7 percent had enophthalmos. A smaller group followed for more than five months, were found to have diplopia in 17 percent and enophthalmos in 11 percent. Of the 29 patients treated non-surgically, none had persistent diplopia.

Diplopia↗
PubMed1977

The risks of major head and neck surgery in the aged population.

A review of 162 major head and neck operative cases for cancer in patients over age 70 from 1963-1973 are reviewed. The major and minor surgical complication rates and the rate of medical complications are compared to 552 similar procedures in patients under age 70, during the same time period. The operative mortality figures for each group, as well as the causes of death, are examined. A plea is made for aggressive therapy in the elderly, both in the surgical planning and in their pre- and postoperative care.

Aged↗
PubMed1976

Reconstruction of the oral cavity with a free flap.

Free groin flaps were used successfully within the oral cavity in 4 patients after ablative operations for cancer. Preoperative or postoperative radiation (cobalt therapy) had no apparent detrimental effect on the survival of these free flaps.

Adult↗