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Biomedical subjects

H Glanz

Publications and source records attributed to H Glanz.

At least 37 records · Page 2Linked to original sources
PubMed1997

Significance of autofluorescence for the optical demarcation of field cancerisation in the upper aerodigestive tract.

BACKGROUND: Second primaries in the upper aerodigestive tract (UADT) are increasingly related to bad prognosis. So early detection of small cancer foci is required to improve the survival rate. Here, autofluorescence (AF) might become useful as in vivo biochemical changes of cancer metabolism can be shown by fluorescence. MATERIAL: For more exact data on AF in cancerous lesions 32 cancer specimens of the UADT and 57 specimens of normal oral mucosa as a control group were examined by using autofluorescent microscopy and spectroscopy, the tissue being activated with light at 365 nm wavelength. Video-controlled in vivo fluorescence examinations in field cancerisation of the UADT were also investigated and compared with pathohistological findings. RESULTS: The intensity of AF of the connective tissue was observed to increase at the tumour border. Contrary to results in the literature, no homogeneous fluorescence gradient could be proved between marginal epithelium and the tumour itself. The brightly shining submucosal elastic fibres allowed fluorescent spectroscopic detection of the tumour margins in vitro in 71%. Even small precancerous lesions were traced in vivo mainly by keratinization when using the autofluorescence diagnostic imaging system. CONCLUSIONS: Our examination proved a multi-factorial genesis of autofluorescence with strong inter-individual variations. Preliminary clinical examination showed that this method can be applied as an additional tool for early detection of cancerous lesions in the UADT.

Carcinoma, Squamous Cell↗
PubMed1996

[Percutaneous catheter embolization in life threatening obstetrical hemorrhage--a case report].

A case of life-threatening postpartum haemorrhage after Caesarean section is reported. The bleeding could finally be stopped by transcatheter embolisation of the internal iliac arteries. Our case and literature concerning management of obstetric haemorrhage by transcatheter embolisation reveals this method to be highly effective, but only slightly invasive and rarely associated with (usually minor) complications. The method is considered to be superior to arterial ligation.

Adult↗
PubMed1996

[Multiple biopsy in diagnosis of laryngeal carcinoma].

BACKGROUND: The fate of patients suffering from laryngeal carcinoma is influenced strongly by the stage of the tumor at the time of diagnosis. This factor is also critical for preservation of the organ. It may be impossible to diagnose the tumor with the first biopsy even though the clinical and macroscopic aspect suggests a malignancy. METHODS: In a retrospective study, we examined 468 patients with laryngeal carcinoma who were treated at the departments of otorhinolaryngology at the University of Basel (B) (198 patients from 1983-1992) or in Giessen (G) (270 from 1990-1995). The number of biopsies necessary to confirm the diagnosis was analysed and the follow-up of the patients was evaluated. Thirty of 32 negative histologic samples were reexamined. RESULTS: Of 468 patients, 32 (7%, 27 [B] 14%; and 5 [C] 2%) required two to six biopsies to confirm the clinically suspected diagnosis: Twenty patients (designated as Group 1) were diagnosed within one to three months, and no patient showed a change of tumor stage within that time. Their first biopsies have to be considered as "nonrepresentative". Eight patients (Group 2) were diagnosed within four to 24 months and four patients (Group 3) more than 24 months after the first biopsy. Final treatment and outcome in patients from Group 1 was unchanged by the time delay in diagnosing the tumor. Seven of eight patients in Group 2 experienced an obvious progression of their tumor during the diagnostic period, which led to laryngectomy in several cases. In four patients, diagnosis was confirmed more than two years after the first biopsy. These were special cases such as development of cancer out of a papillomatosis or chronic laryngitis. CONCLUSIONS: A time delay of three months in diagnosing cancer of the larynx does not have a significant influence on organ preservation and prognosis, even though especially in small tumors suspicion of cancer should lead to a new representative biopsy as fast as possible to preserve the larynx.

Aged↗
PubMed1996

Histomorphological characteristics of non-metastatic lymph nodes in patients with head and neck cancer according to their site in the neck.

The prognostic relevance of histomorphologically defined reaction patterns of lymph nodes was demonstrated in head and neck cancer. Till today the lymph node site in the neck has not been taken into account. Therefore histomorphologically defined reaction patterns of non-metastatic lymph nodes in the neck were examined according to their site in the neck. A total of 1188 dissected neck lymph nodes of 32 previously untreated patients with carcinoma of the head and neck region were examined histologically by serial sections and classified into 6 different lymph node levels and 6 histomorphological types. The objectivity of the morphological examinations could be evaluated morphometrically by means of an interactive image analysis system (IBAS) and a more precise definition of the lymph node reaction types could be established. The results of the morphological and morphometrical classifications show a statistically highly significant relationship (p < 0.0001) between the reaction types of lymph nodes and their site in the neck. These findings allow a division of the neck in an upper anterior half with immunologically active lymph nodes and a lower caudal-dorsal half, which contains essentially less immunologically active lymph nodes.

Carcinoma↗
PubMed1996

[Benzamil and mucoviscidosis. Primary culture of nasal mucosa as an electrophysiologic in vitro model].

The genetic disease cystic fibrosis (CF) is characterized by a defect in the gene encoding for an epithelial chloride channel. This gene product, cystic fibrosis transmembrane conductance regulator (CFTR), in turn leads to a decreased chloride secretion. When this occurs sodium absorption is increased drastically because of an up-regulation of the epithelial sodium channel. In airway epithelia these changes in ion permeabilities result in dehydration of the mucus blanket and impaired mucociliary clearance, and subsequently lead to chronic infections of the airways. In this study we established a primary cell culture of human nasal epithelium from CF and non-CF patients. The increased transepithelial potential in CF exclusively was due to the greater sodium absorption. In previous studies, amiloride was found to specifically block the epithelial sodium channel. Inhalation of nebulized amiloride has been used clinically in the treatment of CF to inhibit sodium absorption and exert a secondary effect on water withdrawal. In the present cell culture model benzamil, an amiloride analogue, was found to inhibit sodium absorption completely, but at strikingly lower concentrations than amiloride. This raises the possibility of using benzamil for inhalation and to provide better efficacy in the symptomatic therapy of patients with CF.

Amiloride↗
PubMed1996

[The pT-classification of primary vocal cord carcinomas and its significance for T-classification].

Since the pretherapeutic T and pT classification of vocal cord cancer according to the UICC has often been found to fail in a high percentage of cases, frequently resulting in an insufficient separation of the different T categories, the pT classification proposed by Glanz was applied in order to obtain a more exact and better reproducible pretreatment system. In a histopathological investigation of 223 previously untreated carcinomas of the vocal cord dating from 1978 to 1988, specimens from total and partial laryngectomies were examined by subserial sectionings. The extension of each lesion was ascertained by measuring tumor in three dimensions per millimeter and determining affected histopathological structures. Neck lymph nodes were also examined for metastases. The different tumor stages were then evaluated with the UICC T/pT classification of Glanz's pT classification. The survival rates and recurrence-free rates of both classification systems were compared. Our evaluation showed that 24% of all the vocal cord cancers studied had to be classified to a higher tumor stage. The pT classification developed by Glanz was better able to separate the different tumor categories than the UICC T/pT classification. Glanz's pT classification system, staging a glottic cancer according to its exact size and laryngeal structures involved, is a significant improvement on the UICC T and pT classification used to date.

Adult↗
PubMed1995

Grading of precancerous laryngeal lesions by multiparameter image analysis at separate epithelial layers.

In order to detect early precancerous changes which do not involve the whole thickness of the epithelium, we used a novel image analysing program based on an IBAS system (Kontron, Germany) to determine nuclear DNA content (NC) as well as average nuclear area (NA) and variation of nuclear area (VA), in the entire epithelium and in three sublayers, parabasal, intermediate, and superficial. DNA aneuploidy was found in only half of the cases classified as 'high-grade' (HG) lesions, comprising carcinoma in situ (CIS) and severe epithelial dysplasias (EDIII), and was chiefly demonstrable in the parabasal third of the epithelium. The other lesions were DNA euploid. HG lesions showed highly significant increases of NA and VA at the lower levels of the epithelium when compared with 'low-grade' (LG) lesions comprising moderate and mild epithelial dysplasias (EDII and EDI). Our data show that the combination of multiparameter image analysis with conventional morphology assists in the objective grading of precancerous lesions and permits the reliable detection of high-grade lesions.

Adult↗
PubMed1995

[Examination technique of ultrasound follow-up of pharyngeal closure after laryngectomy].

BACKGROUND: The pharyngocutaneous fistula presents the most common complication after laryngectomy. Despite applying methods of pharyngeal closure, local factors such as irradiation may cause healing disturbances and the development of pharyngeal fistula. Before the nasogastric feeding tube is removed, an additional radiologic control with water-soluble contrast medium is recommended in literature in case of normal clinical healing. METHODS: The radiologic method was compared with a newly developed sonographic examination technique. Using the so-called "aerophagia maneuver" in sonography, an arising of peripharyngeal air before the "aerophagia maneuver" or a peripharyngeal mass lesion was an uncertain criterion for a pharyngeal fistula. Peripharyngeal air may be seen also due to infection with anaerobic bacteria, and peripharyngeal mass lesion may be caused by seroma or hematoma. In sonography, tissular air is seen typically, in a hyperechoic reflex with distal repetitions. RESULTS: Radiologic examination of the pharynx in 18 laryngectomy patients revealed fistulas in three cases. CONCLUSIONS: Our experiences have shown so far that sonographic examination in combination with the so-called "aerophagia maneuver" prove to be reliable or ascertaining pharyngeal closure after laryngectomy.

Cutaneous Fistula↗
PubMed1995

[Disorders of thrombocyte function as a cause of postoperative hemorrhage after tonsillectomy].

Tonsillectomies are the most frequently performed ENT surgical procedures and are potentially beset with a number of possible complications. Post-operative secondary hemorrhage still remains the most frequent complication despite improvements in surgical techniques and preoperative diagnostic evaluations. Besides unsuitable operative techniques, disturbances of circulation and wound infections, disturbances of hemostasis may play an important part. The objective of this paper was to examine the relative frequency of platelet functional disorders as a possible cause for secondary hemorrhage after tonsillectomies. In the past, most of these have been related to medication use. Eighty-nine patients were studied and historically showed no predisposition increased hemorrhage per se or in their families or gave reasons for other factors favoring secondary hemorrhage. The diminution or lack of collagen or ADP-induced agglutination served as an indication for a platelet functional disorder. Ten percent of the 89 patients experienced secondary hemorrhage, with platelet functional disorders proved in 40% of these patients. Because of these results a correlation was attempted between secondary hemorrhage and abnormal deficits of collagen and ADP-induced agglutinations in platelet functional tests, but this was not found. Necessary preoperative studies was attempted screening for hemostasis as well as medico-legal aspects connected with the prescription of medicines inhibiting platelet agglutination, especially use of acetylsalicylic acid before tonsillectomies, are discussed.

Adult↗
PubMed1994

[Lymphocyte subpopulations in controlled hypotension with sodium nitroprusside].

AIM: Induced hypotension is an anaesthesiological method to reduce blood loss in surgical patients. The aim of this study was to investigate whether induced hypotension with sodium nitroprusside (SNP) causes changes in lymphocyte subpopulations. METHODS: In a prospective randomised evaluation 30 patients undergoing elective oto-rhino-laryngological interventions were studied. In 15 patients SNP was administered to reduce the mean arterial pressure to 50 mmHg. There was a control group of another 15 patients. Anaesthesia was induced with etomidate and maintained with isoflurane. At 7 a.m. on the day of operation (T1), 10 minutes after induction of anaesthesia (T2), 60 minutes after T2 (T3, end of SNP-infusion), 120 minutes (T4) after T2; 180 minutes (T5) after T2, and at 7 a.m. on the following morning (T6) blood samples were taken. A new method (whole blood) was used to mark 6 different lymphocyte subpopulations with monoclonal antibodies which were measured by flow cytometry. RESULTS: In both groups a significant decrease in total lymphocyte count (from 32.7 x 10(9) cells/l preoperatively to 13 x 10(9) cells/l the following morning in the SNP-group and from 31 x 10(9) cells/l to 14.2 x 10(9) cells/l the following morning in the control group) was observed. In the SNP-group the HLA-DR positive T-lymphocytes increased from 11.8% at T1 to 19.2% at T5 and 22.3% at T6. No statistically significant changes were found in percentage of T-, T4-, T8-, B-lymphocytes and natural killer cells. CONCLUSION: The increase in the percentage of activated T-lymphocytes is possibly due to an activation of the sympatho-adrenergic system after sodium nitroprusside-infusion and a subsequent redistribution of these cells from other organs (bone marrow, spleen, lymph nodes). The cell-mediated and the humoral immunity are not altered by induced hypotension. In discussing this result, the age of the patients, the extent of the surgical trauma, the anaesthesiological procedure and the methodological aspects in the lymphocyte assay should be taken into consideration.

Adolescent↗
PubMed1993

Unusual differentiation of a combination tumor of the parotid gland. A case report.

A 67-year-old female patient developed a slowly growing swelling in the region of the left mandibular angle. This swelling was tender on pressure. Clinical examinations revealed an immobile, circumscribed, palpable node. Sonography showed an inhomogeneous space-occupying mass with a predominantly poor echo in the cranial and dorsal parts of the parotid gland. Intraoperatively the lesion presented as a smooth-bordered, round, capsulated tumor, which was excised "in toto". The postoperative course was uneventful. Histologic examination revealed a salivary gland tumor consisting of two components. Glandular structures corresponding to a Warthin tumor were seen in the center, whereas differentiation in the periphery of the tumor was that of a sebaceous lymphadenoma. Metaplastic sebaceous glands within salivary glands have been occasionally described, but true sebaceous lymphadenomas of the salivary glands are a rarity. A rare variant of Warthin's tumor is its metaplastic type, in which extensive metaplasia of the squamous epithelium is observed. The morphologic parallels as well as the differences seen in our case are described. We believe that it does not meet the criteria of a metaplastic Warthin tumor and have therefore diagnosed a combination tumor of the parotid gland, which is composed of a Warthin tumor component and a sebaceous lymphadenoma component.

Adenolymphoma↗
PubMed1993

[Further development in TNM classification of laryngeal cancers].

To prepare an improved TN classification of laryngeal carcinomas, a great number of serial sections of laryngeal cancers and neck dissection specimens has been investigated and corresponding studies of clinical relevance were performed. Our proposals have been accepted in the 1993 supplement of the TNM-UICC classification and will be tested within the frame of so-called ramification studies. The authors propose that the T-category of laryngeal carcinomas should no longer be determined by anatomical areas of different sizes, but by millimetres only (up to 15 mm T1, 15-25 mm T2 a, 25 mm and more without impaired mobility T2 b, to impaired mobility or fixation of vocal cords T3, or T4 if the tumour extends beyond the larynx. The pT categories correspond to the T categories. A histological depth of or less than 5 mm is pT 1 or 2. It is proposed that the differentiation into glottic and subglottic tumours of the larynx should be abandoned. In lymph node metastases, the size, number, level and extranodular spread are considered. N1 and N2 are metastases in the upper two thirds of the neck without fixation (extranodal spread). N1 are one or two ipsilateral metastases of 2 cm or less in diameter, N2 are metastases of more than 2 cm diameter or bilateral metastases. N3 are fixed metastases or metastases in the lower third of the neck. Our proposals are presented in tables, ramification tables, conversion tables and a documentation sheet.

Humans↗
PubMed1993

[The pathogenesis of sinusitis in intensive care patients].

Acute sinusitis is a frequent complication in ventilated intensive care patients and may be a possible source of pneumonia or septicemia. A study of 49 ventilated intensive care neurosurgical patients without previously known disease of the paranasal sinuses or midface fractures was conducted retrospectively from 1989-1990. The kind of intubation used (naso- or orotracheal) was taken into account and the period of ventilation examined in order to determine the genesis of inflammatory changes in the paranasal sinuses (as defined by computed tomography). Intensive care patients suffering from sinusitis showed a characteristic early opacity of the sphenoid sinuses, with lesser involvements in the ethmoid and maxillary sinuses. Only in rare cases and after very long periods of ventilation were the frontal sinuses found to be opaque. Nasotracheal ventilation was observed to produce an earlier attack on the intubated ipsilateral sinuses. These findings indicate that nasotracheal intubation should be avoided if possible or the method of intubation changed as early as feasible. If conservative measures fail sinusitis should best be treated by means of endonasal microsurgical open sinostomy.

Acute Disease↗
PubMed1992

[Examination technique in ultrasound calculus detection in the submandibular gland].

Techniques such as orthopantomography and ultrasound are usually employed for examination for submandibular calculi, but we have found transverse scanning of the submandibular gland by ultrasound to be safe and rapid. As the mandible and hyoid bone present a shadow there is a margin for possible error, but this technique enables these areas to be seen and thus checked: a submandibular calculus may be seen as a third shadow between the other two. Comparison showed ultrasound to be superior to orthopantomography. If the ultrasound is negative and there is a strong clinical suspicion of a submandibular calculus orthopantomography is the next step to be employed.

Diagnosis, Differential↗
PubMed1989

[Treatment of carcinoma of the piriform sinus].

Sixty patients with carcinoma of the piriform fossa were treated with surgery and postoperative irradiation, and 22 other patients with incurable disease were irradiated. All but 2 patients primarily irradiated died within a year. 87% of the 60 patients who were treated by primary surgery had histologically proven lymph node metastases. Twenty six of these patients suffered a local recurrence, regional metastases or distant metastases within 18 months. They were all dead within 2 years of diagnosis of the primary tumor. 75% of patients in this group had shown capsular rupture by metastases. Thirty two of the patients operated on are now free of disease, 23 of them for more than 18 months. Eighteen patients had regional metastases, of whom 6 had caused capsular rupture. The tumor specific 3 year survival was 47.1%. Primary radical surgery followed by radiation therapy is the most effective form of treatment for cancer of the piriform sinus, and should always be advised if possible instead of less mutilating but also less effective forms of treatment.

Carcinoma, Squamous Cell↗
PubMed1989

[Prognosis relevant pathohistologic classification of cervical lymph node metastases (pN) of laryngeal cancer].

A total of 4665 neck lymph nodes from 151 patients with laryngeal cancer treated with primary surgery (laryngectomy plus conservative or radical neck dissection) were examined histologically. In all, 330 lymph node metastases were found and they were classified by size, number, site in the neck, and extranodal disease. These parameters were correlated with survival rates. The present UICC classification system for N/pN is discussed critically, and a pN classification is proposed that is relevant to both histopathology and prognosis.

Germany, West↗
PubMed1989

[Multicentric cancer spread in the mouth cavity and oropharynx].

The clinical entity of multicentric cancerisation comprises multiple carcinomas arising from different anatomical sites and widespread carcinomas of multicentric origin. Over a period of 12 years multicentric cancerisation was diagnosed in 42 out of 150 patients (28%) with primary tumours of the oral cavity or the oropharynx. Patients with multicentric cancerisation are younger at the time of diagnosis of their first primary tumour, and their survival rates are worse compared with patients with only primary tumour. We conclude from our results that a routine panendoscopy should be performed in every patient presenting with a carcinoma of the oral cavity or the oropharynx to rule out a synchronous second primary tumour. Furthermore, these patients should be encouraged to stop smoking, to stop drinking spirits and to undergo regular follow-up examination.

Biopsy↗