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Biomedical subjects

J E Medina

Publications and source records attributed to J E Medina.

At least 19 recordsLinked to original sources
PubMed2001

Early oral feeding following total laryngectomy.

OBJECTIVES: The time to begin oral feeding after total laryngectomy remains a subject of debate among head and neck surgeons. The prevailing assumption is that early initiation of oral feeding may cause pharyngocutaneous fistula; thus, the common practice of initiating oral feeding after a period of 7 to 10 days. The objective of the study was to demonstrate the feasibility and safety of oral feeding 48 hours after total laryngectomy. STUDY DESIGN: Two-part study includes, first, a sequential study and, second, a prospective analysis of our practice. METHODS: Patients undergoing total laryngectomy without partial pharyngectomy or radiation treatment (except irradiation through small ports for a T1 or T2 glottic carcinoma) were included. In the first, sequential part of the study (part I), a group of 18 patients who were fed 7 to 10 days after total laryngectomy (control group) was compared with a group of 20 patients who received oral feeding within 48 hours. To confirm the results of part I, a prospective analysis of this practice was conducted (part II) in which 35 additional patients who met the above criteria were fed within 48 hours after surgery. RESULTS: In part I, pharyngocutaneous fistula occurred in one patient (5%) in the early feeding group and in two patients (11%) in the control group. In part II, pharyngocutaneous fistula occurred in one patient (2.8%). Overall, fistula occurred in two patients in the combined early feeding group (3.6%). This rate of pharyngocutaneous fistula compares favorably with the fistula rate in the control group of 18 patients. Pharyngeal stricture that required dilation occurred in three of our patients in the study group and two in the control group (5.5% vs. 11%, respectively). The length of hospital stay was significantly shortened from 12 to 7 days. CONCLUSION: Our results indicate that in this patient population initiation of oral feeding 48 hours after total laryngectomy is a safe clinical practice.

Adult↗
PubMed2001

Is dissection of level IV necessary in patients with T1-T3 N0 tongue cancer?

OBJECTIVE: Dissection of the lower jugular level of lymph nodes (level IV), as part of an elective neck dissection, has been advocated recently for all patients with oral tongue cancer because of the possibility of "skip metastases" to levels III and IV. The current study was undertaken to evaluate the need to perform a dissection of level IV in patients with oral tongue cancer with no clinical evidence of nodal metastases. METHODS: Fifty-one patients with T1-3, N0 squamous cell carcinoma of the oral tongue were treated with a partial glossectomy and a selective neck dissection of levels I, II, and III. When enlarged nodes were encountered during surgery in level II or III, the dissection was extended to include the nodes in level IV. Involvement of level IV was determined either by the presence of carcinoma on pathological examination or by the development of recurrence in the untreated level IV during a follow-up period of at least 2 years. RESULTS: Level IV was resected as part of the specimen in 17 of the 51 patients and metastatic tumor was found in this level in only one patient. At an average follow-up of 4.1 years, only one patient recurred at level IV, which had been addressed at the initial neck dissection. Consequently, the rate of metastases to undissected level IV was 2%. CONCLUSIONS: Metastases to level IV lymph nodes is rare in patients with T1-T3, N0 oral tongue cancer. Dissection of these nodes only when there is intraoperative suspicion of metastases in levels II or III does not increase the risk or recurrence of tumor in the neck.

Adult↗
PubMed2000

Treatment of giant cell granuloma of the maxilla with intralesional injection of steroids.

BACKGROUND: Giant cell granuloma is rare in the head and neck region and most commonly affects the maxilla and mandible. Although it is a benign disease process, it may be locally destructive. Surgery is the treatment currently recommended. Because of the location of the disease, surgery may be disfiguring. Because it is a benign process, less radical nonsurgical treatment alternatives are desirable. METHODS: A case report of a giant cell granuloma treated with steroid injections. RESULTS: After six weekly intralesional steroid injections, a giant cell granuloma of the maxilla became calcified and smaller. After a follow-up period of 2 years, there was no evidence of regrowth, and the bony osteolytic lesion had filled with bone. A review of the literature revealed two case reports of successful steroid injections with similar response. CONCLUSIONS: Steroid injections are a viable alternative in the treatment of giant cell granuloma, which may avoid surgery.

Adult↗
PubMed2000

Tumor grade, microvessel density, and activities of malate dehydrogenase, lactate dehydrogenase, and hexokinase in squamous cell carcinoma.

Squamous cell carcinomas were evaluated with respect to tumor differentiation (through use of hematoxylin and eosin stain), microvessel density (through use of CD-34 immunocytochemical stain), and magnitudes of malate dehydrogenase (MDH), hexokinase, and lactate dehydrogenase (LDH) enzyme activities. Direct correlations were found between tumor grade, MDH activity, and microvessel density. Direct correlations were also found between hexokinase activity and MDH activity and microvessel density. Inverse correlations were found between LDH activity and both tumor grade and MDH activity. These results suggest that the high rate of glucose utilization (indicated by hexokinase activity) found in more poorly differentiated tumors has a higher component of aerobic oxidative metabolism (indicated by MDH activity) and a relatively lower contribution from anaerobic metabolism (indicated by LDH activity) than do the rates found in more differentiated tumors. It is also suggested that as the glycolytic rate increases, more pyruvate goes into the Krebs cycle than into lactate. The availability of glucose-derived pyruvate for oxidative metabolism would mean less of a dependency on glutamine as a carbon source in squamous cell carcinoma.

Carcinoma, Squamous Cell↗
PubMed1999

Enhanced visualization of parathyroid tissue by infusion of a visible dye conjugated to an antiparathyroid antibody.

BACKGROUND: The antiparathyroid antibody BB5-G1 conjugated to cibacron blue, a blue dye, was intravenously infused to enhance parathyroid visualization. Previously, we demonstrated selective staining of human parathyroid implants in athymic nude mice after infusion of the conjugate. METHODS: Mice possessing implanted parathyroid tissue were randomized into the following: group I, infused with cibacron blue alone; group II, infused with the antibody/dye conjugate; and group III, infused with radiolabeled BB5-G1 alone. Implants were surgically explored. Three blinded observers ranked parathyroid visualization in the operative fields, and corresponding histologic sections were computer analyzed. RESULTS: Group II implants were easily visualized; groups I and III showed no staining. Group III showed high gamma counts. Subjective rankings and computer rankings correlated well (p < .05). Group II showed a higher mean staining intensity of 27.45 picogram protein product (PPP)/cell compared with 7.76 PPP/cell of group I (p = .002). CONCLUSION: Cibacron blue/BB5-G1 consistently enhances visualization of implanted parathyroid tissue.

Animals↗
PubMed1998

Nodal metastases: predictive factors.

Squamous cell carcinoma of the upper respiratory and digestive tract has a high risk for neck metastasis, which reduces the probability of regional control and survival. We analyzed the literature and our own experience to review the possible risk factors for the occurrence of metastasis. The most significant risk factors were: tumor site and size, grade of histologic differentiation, tumor thickness (tongue and floor of mouth carcinoma), vascular embolization, and perineural infiltration. A series of biomarkers has been studied over the last 10 years, but no one has proved to be significant enough for clinical use. Based on several multivariate analysis, it is recommended elective treatment of the neck for high-risk patients.

Adult↗
PubMed1998

Quantitative biochemical analysis of samples from squamous cell carcinoma.

Samples of tumor, tumor stroma, and mixed tumor and stroma were microdissected from three squamous cell carcinomas, as well as from adjacent nontumor tissue and assayed for malate dehydrogenase or lactate dehydrogenase activity as indicators of the relative contribution of aerobic and anaerobic processes, respectively, to energy metabolism. Malate and lactate dehydrogenase activities were greater in tumor tissue than in tumor stroma in all three tumors. However, the magnitudes of malate and lactate dehydrogenase activities were different among the tumors, suggesting that tumors vary in the degree to which aerobic and anaerobic reactions contribute to energy production. These results indicate that a quantitative assessment of enzymes involved in energy production may be a useful probe in the understanding of tumor metabolism.

Carcinoma, Squamous Cell↗
PubMed1996

Parathyroid visualization with cibacron blue/BB5-G1.

BB5-G1 is a murine monoclonal antibody with proven affinity for human parathyroid tissue. The authors conjugated BB5-G1 to cibacron blue, a water-soluble dye, in an attempt to enhance intraoperative parathyroid visualization. Athymic nude mice possessing intramuscularly implanted human parathyroid tissue were infused with the conjugate, then surgically explored. Intraoperative findings were video-captured, then analyzed by three independent observers and by computer, generating subjective and objective data quantifying parathyroid visualization. Parathyroid tissue implants were stained and were easily visualized. The implants in the test mice displayed higher computer-generated color intensity ratings (mean, 10.25 units) compared to control mice (mean, 6.10 units) (p<0.5). Histologic sections confirmed the presence of dye and antibody within parathyroid tissue. This represents the first study to use such a conjugate to selectively enhance parathyroid visualization.

Animals↗
PubMed1994

Accumulation of the p53 tumor-suppressor gene product in oral leukoplakia.

OBJECTIVES: (1) To determine whether the protein of the suppressor gene p53 accumulates in leukoplakia of the oral cavity in individuals who use snuff; and (2) to determine whether a correlation exists between the accumulation of p53 protein and the degree of epithelial dysplasia present in oral leukoplakia. DESIGN: Retrospective analysis of archival tissue specimens. SETTING: The University Hospital, a tertiary referral hospital affiliated with the Oklahoma University Medical Center, Oklahoma City, Oklahoma. PATIENTS: In the first part of the study, biopsy specimens of leukoplakia from 12 persons who used snuff were compared with specimens from uninvolved oral mucosa of the same persons and with biopsy specimens from 12 nontobacco-using persons. In the second part of the study, accumulation of p53 protein was determined in 42 archival paraffin-embedded specimens from oral leukoplakia and correlated with the degree of epithelial dysplasia. METHODS: Accumulation of p53 protein was assessed by immunoperoxidase staining with four different primary antibodies. Positive cells were counted in five consecutive high-power fields. RESULTS: In part one, the average number of positive cells in the leukoplakia of snuff-users (21.89 +/- 4.33; mean +/- SE) was higher than that of normal-appearing mucosa (4.00 +/- 1.0; p < 0.05) and that of nontobacco-using controls (7.00 +/- 5.04). In part two, the average number of positive cells was higher in the moderately dysplastic (140.36 +/- 30.03) and severely dysplastic lesions (232.86 +/- 26.85) than in the mildly dysplastic lesions (14.53 +/- 3.33; p < 0.05). The correlation between the degree of epithelial dysplasia and the number of cells positive is strong (Spearman's correlation coefficient = 0.853). CONCLUSIONS: The accumulation of p53 protein in leukoplakia of snuff-users is higher than in normal-appearing oral mucosa from both snuff-users and nontobacco-using controls. A strong correlation exists between the degree of epithelial dysplasia present in oral leukoplakia and the number of cells staining positive for p53. The accumulation of p53 protein holds potential as an intermediate end point in studies of chemoprevention of oral cancer.

Biomarkers, Tumor↗
PubMed1993

Malignant melanoma of the head and neck.

The incidence of cutaneous malignant melanoma is increasing in the United States and throughout the world at an alarmingly rapid rate. Melanoma, however, is a highly curable cancer when diagnosed and treated appropriately at an early stage. This article provides current information about the epidemiology, risk factors, and the principles as well as the controversies associated with the diagnostic evaluation and treatment of patients with this neoplasia.

Head and Neck Neoplasms↗
PubMed1992

Markers of keratinocyte differentiation in snuff-induced leukoplakia.

Biopsy specimens from 12 patients who used snuff and had leukoplakia in the mucosa of the oral cavity were studied and compared with specimens from their own nonleukoplakic oral mucosa, as well as with biopsy specimens from corresponding areas of the oral cavity in 12 nonsmoking, nontobacco-using control subjects. The biopsy specimens were processed using standard immunohistochemical rabbit antibody to human involucrin and mouse antibody to human transglutaminase type I as the primary antibodies. A computer-driven light absorbance image analysis system was used to determine the optical density of each of the marker-stained specimens. Optical density measurements were compared using a one-way analysis of variance. The expression of involucrin was significantly higher in the epithelium of the nonsmoking, nontobacco-using control subjects (0.2937 +/- 0.0725 optical density) in comparison with the normal-appearing mucosa (0.2283 +/- 0.0488 optical density) and the leukoplakic mucosa of the snuff-using patients (0.2007 +/- 0.0669 optical density) (p < 0.05). The expression of transglutaminase type I was also significantly higher in the epithelium of the nonsmoking, nontobacco-using controls (0.2308 +/- 0.1381 optical density) than in the patients with leukoplakic mucosa (0.1310 +/- 0.0472 optical density) (p < 0.05). However, there was no difference when compared with the normal-appearing mucosa of the patients in the snuff-using group (0.1686 +/- 0.0323 optical density). This study has shown that involucrin and transglutaminase type I are expressed differently in leukoplakic oral mucosa of snuff users and in normal oral mucosa and that this difference can be measured objectively.

Adult↗
PubMed1991

Standardizing neck dissection terminology. Official report of the Academy's Committee for Head and Neck Surgery and Oncology.

The emergence of the multitude of modified techniques for neck dissection procedure has resulted in a nomenclature system that is nonuniform. To eliminate potential misinterpretation, overlap, and lack of standardization, the Academy's Committee for Head and Neck Surgery and Oncology, with input from the Education Committee of the American Society of Head and Neck Surgery, has developed a classification system for these procedures. This has now been adopted by the American Academy of Otolaryngology-Head and Neck Surgery. The classification is based on the following concepts: (1) radical neck dissection is the fundamental procedure with which all other neck dissections are compared, (2) modified radical neck dissection denotes preservation of one or more nonlymphatic structure(s), (3) selective neck dissection denotes preservation of one or more group(s) of lymph nodes, and (4) extended radical neck dissection denotes removal of one or more additional lymphatic and/or nonlymphatic structure(s). Adherence to the principles of this classification system to describe neck dissection techniques should provide an improved method of communication. Furthermore, the system provides a rational framework on which subsequent terminology can be added.

Head and Neck Neoplasms↗
PubMed1990

Lateral temporal bone resections.

Eighteen consecutive patients underwent a lateral temporal bone resection for the treatment of tumors originating in the auricle, the external auditory canal, the periauricular skin, or the parotid and were retrospectively analyzed. The different lateral temporal bone resections performed have been categorized into four types. The type I resection consists of the removal of the tympanic bone and the external auditory canal lateral to the tympanic membrane. The type II resection consists of the removal of the entire tympanic bone, the tympanic membrane, the incus, and the malleus, preserving the facial nerve and the inner ear. Type III resections remove, in addition to the those structures removed in type II resections, the distal facial nerve and fallopian canal, the mastoid tip, the styloid process, and the stylomastoid foramen. The type IV resection consists of the removal of only the mastoid tip and the inferior portion of the tympanic bone. When the techniques of lateral temporal bone resection are used appropriately, adequate surgical treatment of patients with selected advanced and recurrent malignant tumors of the external ear, the periauricular skin, and the parotid is possible with low morbidity and a high probability of local regional control.

Adult↗