[Mandible resection in mouth cancer--rim resection versus continuity resection].
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Biomedical subjects
Publications and source records attributed to J Kreidler.
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Twenty-two patients with squamous cell carcinoma of the oral cavity were treated intra-arterially with epirubicin and cisplatin. Biopsies were taken before, during, and after treatment and analysed by DNA flow cytometry. Clinical response to therapy was better in the diploid group as well as in previously aneuploid tumors which showed complete disappearance of the abnormal clone in the course of treatment. Poor reduction of tumor volume corresponded with persistence of aneuploid cells.
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The cellular DNA content of 90 primary squamous cell carcinomas of the floor of mouth was determined by flow cytometry. Aneuploid cell lines were detected in 86% of the cases. The proportion of diploid carcinomas decreased with size (T1: 63%, T2: 11%, T3: 7%) and histologic grade (G1: 17%, G2: 16%, G3: 9%). Only 15% of the diploid, but 61% of the aneuploid tumors showed evidence of lymph node involvement. A 96% sensitivity of the test and a negative predictive value of 85% emphasize the prognostic importance of DNA ploidy in the primary tumor to evaluate the risk of subclinical dissemination.
The clonal DNA content of tumor biopsy specimens of 110 patients with primary and untreated squamous cell carcinoma of the oral cavity was determined by flow cytometric study. The ploidy status was compared with tumor size and histologic grading. Thirty tumors (27.3%) were diploid; in 80 cases (72.7%) cell lines with abnormal DNA content were detected. The portion of aneuploid tumors increased with decreasing degree of histologic differentiation (P less than 0.001) from G1 (38.1%) to G2 (76.6%) and G3 (92.0%). Only one of 13 T1 carcinomas (7.6%) showed abnormal clonal DNA content, but 76.9% of T2 and 90.6% T3 tumors (P less than 0.001) did. The emergence of aneuploid clones obviously represents a marker of malignancy progression in oral carcinoma.
The exact regional correlation of findings of facial bone scans, planar or SPECT, to dental orthopan X-ray films (OPT) is difficult because of the very different projection techniques. To improve correlative imaging in this regard a projection algorithm was developed that uses SPECT data of the skull for reconstructing an orthopan tomoscintigraphic projection. Fourteen conventional SPECT slices of the upper and lower jaws were obtained during bone scanning. All mandibular slices were superimposed resulting in a horseshoe shaped structure, while was marked by an ROI which was divided into segments. All 14 SPECT slices were then masked by this segmental ROI, thereby marking the teeth-carrying bone in all slices. The information from this horseshoe like ROI is then transformed into lines. Line by line arrangement results in an orthopan projection, the orthopan tomoscintigram. This new display allows 1:1 true scale superimposition with the X-ray OPT and markedly facilitates correlative imaging.
A total of 47 primary squamous cell carcinomas of the tongue were analysed by DNA flow cytometry. With respect to their clonal DNA content two distinct tumor groups could be distinguished. In 14 cases the tumors (29.8%) were dipoid, whereas in 33 cases (70.2%) additional cell lines characterized by abnormal DNA content could be detected. A significant increase of aneuploid cases with tumor size as well as with decreasing histological differentiation could be detected. Aneuploid cell lines are lacking in T1 as well as in most G1 carcinomas but predominate in T3 and G3. Furthermore, cervical lymph node involvement was recognized in the majority of aneuploid primary carcinomas (81.8%) but was largely lacking in diploid tumors (21.4%). Hence, the presence of aneuploid cell lines is clearly connected with clinical and histopathological parameters, each of which have turned out to worsen the prognosis in tongue carcinomas.
Clinical, radiographic and microscopic features of 8 ossifying fibromas diagnosed in 7 patients and measuring more than 8 cm in greatest diameter, were reviewed. The tumors occurred in both juvenile and middle aged patients and all lesions in women involved the maxilla. The abundance of fibrous connective tissue and resorption of mineralized deposits are indicative of altered cellular differentiation and proliferative activities in large ossifying fibromas. Focal areas of aneurysmal bone cyst formation were identified in the majority of lesions.
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The therapy of chronic facial pain poses an interdisciplinary problem. Since 1984 the therapeutical plan of Ulm University was developed in such a way that the intensity of pain and the location as well as former treatments are accommodated. The therapeutical steps don't interfere among one another. In the first four years 204 patients were treated with this scheme. A freedom or at least a reduction of pain was achieved in 187 patients.
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