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Biomedical subjects

H J Pelzer

Publications and source records attributed to H J Pelzer.

18 recordsLinked to original sources
PubMed2003

Concurrent chemoradiotherapy for N2 or N3 squamous cell carcinoma of the head and neck from an occult primary.

BACKGROUND: Our aim was to explore the use of concurrent chemoradiotherapy in the management of patients with squamous cell carcinoma of the head and neck from an occult primary (HNCOP). PATIENTS AND METHODS: From 1991 to 2000, 25 patients with T0N2M0 or T0N3M0 HNCOP were entered into five sequential phase II clinical trials. Chemoradiotherapy consisted of a split course of radiotherapy with concurrent 5-fluorouracil and hydroxyurea either alone or with cisplatin, or paclitaxel. Two of the five protocols incorporated induction chemotherapy. RESULTS: Nodal stage was N2a in five patients (20%), N2b in 13 (52%), N2c in one (4%) and N3 in six (24%). Twenty-two patients (88%) underwent neck dissection; 14 of 22 patients underwent neck dissection before initiating protocol therapy. Total radiation doses of 55-75 Gy (median 60 Gy) were delivered; radiation fields included the potential sites of mucosal primaries and the neck bilaterally. Selected patients received a radiation boost to the involved neck. With a median follow-up of 3.9 years, three patients have progressed (one local, two distant) and seven patients have died. Deaths were due to disease progression (three) or unrelated causes (four). No metachronous primaries developed. The 5-year progression-free and overall survival was 87% and 75%, respectively. CONCLUSION: Combined-modality treatment with intensive chemoradiotherapy results in excellent disease control and long-term survival for patients with N2-N3 HNCOP and compares favorably with traditional therapy.

Adolescent↗
PubMed2000

Overexpression of p53 in squamous cell carcinoma of the tongue in young patients with no known risk factors is not associated with mutations in exons 5-9.

BACKGROUND: This study investigated the status of the p53 tumor suppressor gene in patients less than 40 years of age who had squamous cell carcinoma of the tongue develop with no known risk factors. METHODS: Histologic sections from 21 patients were prepared from formalin-fixed, paraffin-embedded tissue and were processed for standard immunohistochemistry for detection of the p53 protein. In addition, tumors were evaluated by single-strand conformation polymorphism and by DNA sequencing to identify potential mutations in the conserved exons (5-9) of the p53 gene. RESULTS: Eighty-one percent (17 of 21) of the patients overexpressed p53 by immunohistochemical analysis. However, none of these patients demonstrated mutations in exons 5-9 of the gene. CONCLUSIONS: These data suggest that the molecular mechanisms by which the young individuals with no risk factors had altered p53 function in oral squamous cell carcinoma may differ from those of the more typical population of individuals who have this malignancy develop.

Adolescent↗
PubMed1999

Nitric oxide synthase type 3 is increased in squamous hyperplasia, dysplasia, and squamous cell carcinoma of the head and neck.

The implication of nitric oxide (NO*) in the multistep process of carcinogenesis prompted us to examine the expression of endothelial constitutive nitric oxide synthase (NOS3) in head and neck squamous cell carcinoma (HNSCCa). Eleven paraffin-embedded samples of normal oral mucosa, 3 reactive oral lesions, 13 samples of squamous dysplasia, and 120 specimens of HNSCCa were immunostained with an anti-NOS3 monoclonal antibody and graded on a 0 to 4+ scale of intensity. Normal squamous mucosa demonstrated very little NOS3 expression. Areas of normal mucosa, reactive mucosa, and dysplastic lesions associated with inflammation tended to demonstrate regional expression of NOS3. Reactive mucosal lesions, squamous dysplasia, and HNSCCa demonstrated a significant (p<.0001) increase in global expression of NOS3. Therefore, NOS3 is expressed very little in histologically normal squamous mucosa, while squamous hyperplasia, dysplasia, and HNSCCa express significantly more NOS3. Regional variation in NOS3 expression appears to be associated with perilesional inflammation.

Antibodies, Monoclonal↗
PubMed1999

Results of gastric interposition for reconstruction of the pharyngoesophagus.

BACKGROUND: Free jejunal transfer has become the standard technique for reconstruction of the proximal pharynx and hypopharynx. Gastric tube interposition is an effective alternative when resection extends below the thoracic inlet. This study was done to determine current indications, review morbidity and mortality rates, and to define clinical and pathologic determinants of survival associated with this procedure. METHODS: We reviewed the records of 32 patients who underwent gastric tube interposition for reconstruction of the pharyngoesophagus from 1987 to 1997. RESULTS: The overall complication rate was 50%. Complications were more frequent in the reoperative group (22% vs 66%, P < .05). The overall fistula rate was 31%. The overall mortality rate was 12%. Ultimately, 71% of patients resumed oral feedings. The 5-year actuarial survival rate was 22%. Unfavorable prognostic factors associated with significantly reduced survival (P < . 05) included margin positive resection, positive lymph node involvement, and operations done for recurrent tumor CONCLUSIONS: Reconstruction of the pharyngoesophagus with gastric tube interposition is indicated for primary tumors of the hypopharynx and cervical esophagus with inferior extension below the thoracic inlet and recurrent tumors or benign strictures in which free jejunal transfer is not feasible or has failed. It can be done with acceptable morbidity and mortality and provides reasonable expectations for long-term survival and resumption of oral intake.

Adult↗
PubMed1997

Phase II study of induction and adjuvant chemotherapy for squamous cell carcinoma of the head and neck. A long-term analysis for the Illinois Cancer Center.

BACKGROUND: In 1982, the Illinois Cancer Center initiated a Phase II trial in which the following treatment was administered: Induction chemotherapy (cisplatin and infusional 5-fluorouracil [5-FU]) was administered before definitive local therapy. Definitive local therapy, consisting of surgery, radiation, or both, was followed by three cycles of the same chemotherapy program. METHODS: Eligible patients had Stage III or IV squamous cell carcinoma of the head and neck with no distant metastases. Three cycles of induction chemotherapy were given. Cisplatin, 100 mg/m2, was infused over 60 minutes on Day 1; thereafter, 5-FU (1000 mg/m2/day) was given continuously for 5 days. Cycles were repeated at 3-week intervals. Local therapy was individualized, according to tumor stage and site. Patients who responded were to receive an additional three cycles of chemotherapy after surgery or radiation. RESULTS: Eighty-one patients were entered into the trial, and 71 were considered both eligible and evaluable. After induction chemotherapy, 59 patients (83%) responded, 23 of whom experienced complete response. Sixty-nine patients completed definitive local treatment, but only 22 proceeded to the planned adjuvant cycles of treatment. Median follow-up of surviving patients was 12 years. At last follow-up, 13 patients were alive and free of malignancy, 9 of whom never had disease recurrence or a second primary tumor. These 13 patients had an acceptable quality of life, were ambulating, and were fully capable of caring for themselves. Overall, nine patients had second primary malignancies. Thirty-four percent of patients were alive at 5 years, and 21% were alive at 10 years. Of 58 deaths, 44 resulted from progressive disease and 8 resulted from second primary cancers. Four patients died of unrelated causes, and two suffered lethal acute toxicity from the chemotherapy program. Late toxicity was moderate. Among 23 patients surviving at least 6 years, there were 3 cases of hypothyroidism, presumed to be secondary to radiation. Xerostomia was modest, consistent with usual radiation effects. Of the 13 patients who were alive and free of malignancy at last follow-up, none had clinical manifestations of serious late end organ toxicity. CONCLUSIONS: During long term follow-up after multimodal treatment of locally advanced squamous cell carcinoma, no obvious benefit was observed from the chemotherapy component of the treatment regimens rendered. Only 21% of patients achieved 10-year survival with the following causes of failure, in descending order of frequency: disease recurrence, second malignancies, other medical problems, and treatment-related deaths. The results of this trial are consistent with the results of other induction chemotherapy trials, indicating the need for innovative treatment strategies. These data do not support the continued use of induction chemotherapy with the cisplatin and infusional 5-FU program.

Adult↗
PubMed1995

Serum immunoglobulins specific for intracellular proteins of squamous cell carcinoma.

OBJECTIVE: To determine an autologous humoral immune response to squamous cell carcinoma (SCC) intracellular proteins in patients with SCC. DESIGN: Intracellular proteins were isolated from 25 different cultured SCC lines. The proteins were used as a source of antigens to measure IgA, IgE, and IgG responses in the serum samples of patients and controls. Antibody response was assessed in both unfractionated and fractionated intracellular proteins. PATIENTS: The serum samples of 65 patients with SCC and of 65 age- and gender-matched controls were tested. RESULTS: Antibodies to SCC intracellular proteins were detected in the serum samples of 40 (62%) of the 65 patients with SCC and in the serum samples of 46 (71%) of 65 controls. Thirty (46%) of the patients with SCC and 40 (62%) of the controls had IgE responses, 18 (28%) of the patients and one (2%) of the controls had IgA responses, and 17 (26%) of the patients and 14 (22%) of the controls had IgG responses. An inverse relation was noted between detectable IgE responses and IgA or IgG responses in the patients and the controls. The analysis of antibody response indicated that 28 molecules were recognized predominantly by the serum samples of patients with SCC, but not by the serum samples of controls. CONCLUSIONS: A substantial proportion of patients with SCC and of controls exhibited an autologous humoral immune response to SCC intracellular proteins. The IgE responses to SCC intracellular proteins were inversely related to IgA or to IgG responses. Different antibody isotypes normally cause markedly different immune functions, and may suggest different roles for the existent immune responses to SCC antigens. We identified many tumor-associated antigens that were selectively recognized by the serum samples of patients with SCC. These antigens could be used to define molecular studies of immune surveillance and selection, and may represent appropriate targets for immunotherapy.

Autoradiography↗
PubMed1992

The pectoralis major myofascial flap for intraoral and pharyngeal reconstruction.

The pectoralis myocutaneous flap has been widely used for reconstruction of oral cavity and pharyngeal defects. However, it has several disadvantages, such as chest distortion, hair growth at the reconstructed site, and excessive bulk, all of which can be avoided by the use of the pectoralis myofascial flap. Oral cavities and pharyngeal defects, ranging in size from 4 to 9 cm in largest' dimension, in 26 patients were reconstructed with the pectoralis myofascial flap. All but three defects were successfully reconstructed. The surface of the flap was covered by squamous epithelium in 1 month. The flap remained healthy during and after radiotherapy. The pectoralis myofascial flap is ideal for soft-tissue coverage of small- to medium-size oral cavity and pharyngeal defects. Its major advantages over the pectoralis myocutaneous flap are decreased bulk and improved cosmesis.

Female↗
PubMed1991

Hydroxyapatite cement. I. Basic chemistry and histologic properties.

Hydroxyapatite cement is a unique calcium phosphate preparation that can be shaped intraoperatively and sets in vivo to an implant composed of microporous hydroxyapatite. The histologic response to this cement was evaluated by implanting disks made of this material within the heads of nine cats. Three sets of 12 hydroxyapatite cement disks were produced containing 0%, 10%, and 20% macropores by volume, respectively. The disks were implanted subcutaneously, intramuscularly, above the periosteum of the skull, and directly onto the surface of the calvarium. Each macropore percentage was represented in each tissue plane, and animals were killed up to 9 months postoperatively. There were no toxic reactions, implants extruded, or wound infections. Histologic examination of the implant-soft-tissue interfaces revealed a transient inflammatory response without foreign body reaction. The disks were resorbed over time in direct proportion to their macropore content (surface areas) in all groups except for those disks placed directly onto the surface of the calvarium below the periosteum. In this group, numerous foci of bone formed at the skull-implant interface, with variable replacement of the deep surface of these implants by bone. Implant replacement by bone is postulated to occur through a combination of implant resorption coupled with osteoconduction. Based on these properties, hydroxyapatite cement may prove useful when applied to the reconstruction of non-stress-bearing skeletal tissue.

Animals↗
PubMed1991

Hydroxyapatite cement. II. Obliteration and reconstruction of the cat frontal sinus.

Frontal sinus obliteration and reconstruction can be performed with autogenous grafts or synthetic implants, each of which has significant limitations. Hydroxyapatite cement, which can be shaped intraoperatively and sets to a microporous hydroxyapatite implant, was applied to this problem. Nine cats had the anterior table of their frontal sinus unilaterally removed and the sinus cavity stripped of its mucosa. Hydroxyapatite cement was used to obliterate the cavity and reconstruct the overlying anterior table defect. The unoperated side served as the control, and the animals were sacrificed up to 18 months postoperatively. There were no adverse reactions, infections, mucoceles, or implant extrusions. The normal anatomic contour of the forehead region overlying the hydroxyapatite cement implants was maintained in all animals. Histologic examination of undecalcified whole sinus sections revealed progressive replacement of the implants with woven bone without a loss of volume. Replacement of the hydroxyapatite cement by woven bone is postulated to occur through a combination of implant resorption coupled with osteoconduction. The use of hydroxyapatite cement proved successful for the reconstruction and obliteration of cat frontal sinuses, and may be appropriate for the same application in humans.

Animals↗
PubMed1990

Segmental mandibular regeneration by distraction osteogenesis. An experimental study.

We report the use of distraction osteogenesis for segmental mandibular regeneration. This technique has been used in thousands of patients in the Soviet Union to regenerate as much as 30 cm of tubular bone in the extremities. However, we are unaware of previous experimental or clinical reports of segmental mandibular regeneration by distraction osteogenesis. In a canine model, 2.5-cm segmental mandibular defects were filled with regenerate bone in 25 days at a rate of 1.0 mm/d using bifocal distraction osteogenesis. The diameters of the regenerate segments were comparable with preexisting mandible, and all animals resumed normal oromandibular function following regeneration. The regenerate bone was evaluated radiographically, angiographically, and histologically. In the control group without distraction osteogenesis, the segmental defects failed to fill with regenerate bone. The theoretical basis for distraction osteogenesis, a detailed description of the technique, and a review of previous studies on experimental mandibular lengthening are presented.

Animals↗
PubMed1989

Neurofibromatosis type II of the head and neck.

Neurofibromatosis type II (NF-II) has been traditionally referred to as "acoustic" neurofibromatosis and is not known to be genetically distinct from classic von Recklinghausen's disease (NF-I). Neurofibromatosis type II is due to a lesion on chromosome 22q, while von Recklinghausen's neurofibromatosis is from a defect on chromosome 17. The approximate incidence of NF-II is one in 50,000, with bilateral acoustic neuromas occurring in over 90% of those with the abnormal gene. We studied a 17-year-old boy with NF-II who presented with bilateral acoustic neuromas and concomitant primary nasopharyngeal meningioma. Less than 30 nasopharyngeal meningiomas have been documented, and the presence of both tumor types in the same individual is unique in the literature.

Adolescent↗
PubMed1985

Staging system by sites. Problems and refinements.

Staging by sites has been met with varying degrees of acceptance by the medical community. Only painstaking application of these guidelines will provide the necessary information for revision of the present system.

Head and Neck Neoplasms↗
PubMed1984

Potential applications of photoradiation therapy in head and neck surgery.

Current theories of carcinogenesis suggest that premalignant changes should be expected in any area of the mucous membrane exposed to a carcinogen. The place of triple endoscopy in the workup and management of head and neck malignant neoplasms has been well established. Hematoporphyrin derivative has been shown to lend reproducible results in the study of tumor fluorescence. This compound has been used in in vitro and in vivo diagnosis and in the treatment of various tumors. It has not been used extensively in the head and neck, but its properties are ideal for diagnosis and treatment of selected head and neck tumors. Potential applications of photoradiation therapy in otolaryngology-head and neck surgery include detection of small primary tumors, delineation of resection margins, detection of early recurrences, and palliative and curative therapy of lesions.

Antineoplastic Agents↗
PubMedDate not supplied

Primary ectopic meningioma of the maxillary sinus: case report and review of the literature.

METHODS: A case of a primary ectopic meningioma, arising within the right maxillary sinus, is presented. A review of English literature was also undertaken to determine the prevalence of these lesions in this specific anatomic location. RESULTS: A total maxillectomy was performed without complications and the surgical defect was covered with an immediate obturator. The patient is well and without evidence of disease 3 1/2 years postoperatively. A review of the English literature revealed four additional reports of primary ectopic meningiomas that were limited to the maxillary sinus. CONCLUSIONS: Primary ectopic meningiomas of the maxillary sinus are uncommon lesions which have a good prognosis when a complete resection of the neoplasm can be performed.

Adolescent↗
PubMedDate not supplied

Management of chronic aspiration by subtotal and submucosal cricoid resection.

Modern techniques of conservation surgery of the laryngopharynx often result in narrowing, immobility, and decreased sensation of the hypopharynx. These procedures also compromise the most vital function of the larynx--protection of the airway. Permanent tracheostomy is always necessary for protection of the airway. Teflon injection, cartilage implant to the larynx, and extended pharyngeal myotomy can provide only temporary relief. Swallowing studies under fluoroscopy as well as laryngopharyngoscopy verify a narrowed pharyngeal inlet with the pharynx trapped between the cricoid and the cervical spine. Extrapharyngeal, subtotal, submucosal resection of the posterior cricoid ring results in a flaccid posterior laryngeal wall and enlarged hypopharyngeal inlet. At the same time the laryngeal inlet is narrowed, reducing aspiration and still preserving the voice.

Animals↗