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Biomedical subjects

J L Gluckman

Publications and source records attributed to J L Gluckman.

At least 19 recordsLinked to original sources
PubMed1992

Cytomegalovirus infection of the larynx in the acquired immunodeficiency syndrome.

CMV is the most important viral opportunist in patients with AIDS. Nearly all patients with AIDS have been exposed to CMV and the virus can be isolated from many. When CMV-related disease occurs in AIDS, it has usually involved the eye or gastrointestinal tract. In lesions in which CMV is the suspected etiology, evidence of direct pathogenicity of the virus should be obtained, usually histologically. Accurate diagnosis is essential because long-term therapy with a relatively toxic drug (ganciclovir) is indicated. We have presented a case of CMV infection of the larynx that responded, albeit slowly, to ganciclovir. Additional cases may arise as the prevalence of AIDS increases. Because of the potential for airway compromise and the tendency toward chronicity, CMV infection of the larynx should be of a significant concern both for the patient and the otolaryngologist.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Low incidence of point mutation at codon 12 of K-ras proto-oncogene in squamous cell carcinoma of the upper aerodigestive tract.

Forty-two cases of squamous cell carcinoma arising in the upper aerodigestive tract were examined to determine the incidence and type of point mutation in codon 12 of the c-K-ras gene by using the polymerase chain reaction and oligonucleotide hybridization techniques on DNA extracted from paraffin blocks. DNA sequencing, in addition, was performed in 4 cases. No point mutation was detected in codon 12 of c-K-ras in the 42 squamous cell carcinomas we examined. According to the results of DNA sequencing of 4 cases, codon 13 also revealed no point mutation. Thus, point mutational activation of codon 12 of c-K-ras oncogene is an uncommon event in human upper aerodigestive tract squamous cell carcinoma.

Adult↗
PubMed1991

Hematoporphyrin photodynamic therapy: is there truly a future in head and neck oncology? Reflections on a 5-year experience.

Photodynamic therapy, which consists of the selective destruction of tumors using a combination of a photosensitizer administered systemically (dihematoporphyrin ether) and an argon dye-pumped laser, has provoked profound interest amongst oncologists and has particularly titillated head and neck oncologists with its potential. Unfortunately, no multi-institutional trials for head and neck tumors have been introduced, and the literature is replete with anecdotal reports from individual researchers on the management of advanced cancers for palliation, superficial early cancers, and field cancerization of the mucosa ("condemned mucosa"). A personal 5-year experience with 41 head and neck cancers was reviewed, as was the current literature. An attempt was made to place in perspective the true role and future direction of this technology.

Carcinoma, Squamous Cell↗
PubMed1991

The use of bromodeoxyuridine cytokinetic studies as a prognostic indicator of cancer of the head and neck.

Traditional measures of head and neck tumors often fail to predict patient outcome or clinical course, particularly in nonadvanced disease. This problem of unpredictable tumor behavior has been one focus of cell proliferation studies. Such studies, however, have been limited by difficult methodology. A newer method of quantifying tumor cell proliferation using bromodeoxyuridine is applicable for head and neck squamous cell carcinomas, as shown in the present study. The relative ease with which cell proliferation can be evaluated using this technique will allow large numbers of head and neck tumors to be studied, enabling correlations with tumor behavior to be made.

Adenoma↗
PubMed1991

Photodynamic therapy for head and neck neoplasms.

A comprehensive updated review of the current status of photodynamic therapy using hematoporphyrin and the argon dye-pumped laser is presented. Indications, advantages, and disadvantages of photodynamic therapy are stressed, and future directions for research are suggested.

Head and Neck Neoplasms↗
PubMed1990

The expression of alpha vascular smooth-muscle actin in salivary gland tumors.

In an attempt to determine if both pleomorphic adenomas and adenoid cystic carcinomas are derived from myoepithelial cells, 23 pleomorphic adenomas, 22 adenoid cystic carcinomas, and 17 normal salivary glands were examined immunohistochemically by using monoclonal antibodies directed against actin (HUC1-1, 1A4), keratin (AE-1, 34 beta E 12), and vimentin (V9). In normal salivary glands, the myoepithelial cells demonstrated a positive reaction to the monoclonal antibodies against actin and only rarely reacted with those against vimentin. No reaction to those against keratin was noted. In pleomorphic adenomas, cells that histologically resembled myoepithelial cells displayed a positive reaction to HUC1-1 in 60.9% and to 1A4 in 65.2%. In adenoid cystic carcinoma, 59.1% of cases demonstrated a positive reaction to both HUC1-1 and 1A4. These results supported the hypothesis that the majority of pleomorphic adenomas and adenoid cystic carcinomas arise from cells of myoepithelial origin.

Actins↗
PubMed1990

Orbital hemorrhage during ethmoid sinus surgery.

Orbital hemorrhage is an unusual complication of ethmoid surgery. A case of intraoperative orbital hemorrhage occurring during a medial maxillectomy and one occurring during a transethmoid sphenoidotomy are presented. The pathogenesis of this potentially serious complication is discussed. A sequential treatment algorithm is presented, consisting of medial orbitotomy, lateral canthotomy and inferior cantholysis, and inferior orbital decompression, along with concomitant medical management with mannitol, acetazolamide, and dexamethasone.

Acetazolamide↗
PubMed1990

Current management of carcinoma of the oropharynx.

A substantial proportion of head and neck cancers develop in the oropharynx. The anatomy of this area is quite complex as many vital structures are located nearby. Most oropharynx malignancies are squamous cell carcinomas, although other histologic types occur on occasion. The prognosis is dependent on the histologic type, the site(s) involved, and the stage of the tumor. Early disease may be managed equally well by either radiation therapy or surgery; advanced tumors generally require combination therapy. Major advances have occurred in reconstruction following resection. If diagnosed early enough, the prognosis for these cancers is quite good.

Combined Modality Therapy↗
PubMed1988

Paecilomyces variotii. An unusual cause of isolated sphenoid sinusitis.

Isolated fungal sphenoid sinusitis is an unusual head and neck infection. We describe the first reported case (to our knowledge) of Paecilomyces variotii sphenoid sinusitis. In addition, it represents one of the few reported cases of isolated fungal sphenoid sinusitis. Diagnosis and management of this condition are described. Aggressive surgical management is advocated when fungal sphenoid sinusitis is suspected.

Aged↗
PubMed1988

Microvascular reconstruction of the pharyngoesophagus with free jejunal graft.

Free jejunal graft reconstruction of the pharyngoesophagus has become reliable one-stage technique, but the microsurgeon must be aware of numerous pitfalls. Forty-two patients were retrospectively reviewed. There were four graft failures for a success rate of 90.5%. When harvesting the graft the thick fatty mesentery may make dissection difficult, and injuries to the mesenteric artery and vein can occur. Neck preparation can be tedious because of previous radiation, and size discrepancies with the carotid branches and the mesenteric artery are seen. Intimal dissection of the mesenteric artery can present as an isolated flap or a circumferential "rosette," despite the most careful preparation of the vessels; and great care must be taken in the microvascular anastomosis. The end-to-end arterial anastomosis to a branch of the external carotid and an end-to-side venous anastomosis to the internal jugular were preferred. Vein grafts are occasionally necessary.

Adolescent↗
PubMed1987

Partial vs total esophagectomy for advanced carcinoma of the hypopharynx.

Cancer of the hypopharynx is an aggressive disease with a poor prognosis irrespective of the therapeutic regimen instituted. Controversy centers around the extent of surgery required to adequately ablate the advanced cancers, particularly related to the role of esophagectomy. A literature review and analysis of 43 cases of advanced hypopharyngeal cancer treated with total laryngopharyngectomy and partial esophagectomy support the argument that in carefully selected situations, a partial esophagectomy is oncologically an adequate operation.

Aged↗
PubMed1987

Giant cell reparative granuloma of the ethmoid sinus.

This article represents the fourth and fifth reported cases of GCRG that involve the ethmoid sinus. The problems encountered in establishing the diagnosis are emphasized, as are the features that differentiate it from the giant cell tumor, aneurysmal bone cyst, and hyperparathyroidism, the conditions with which it is most commonly confused. The unusually aggressive behavior, as demonstrated by these two cases, is highlighted.

Adult↗
PubMed1987

Surgical salvage for stomal recurrence: a multi-institutional experience.

Recurrence of squamous cell cancer following total laryngectomy constitutes an extremely difficult therapeutic problem. Satisfactory management is elusive and frustrating to the head and neck oncologist. Various recommended therapeutic regimens include symptomatic treatment, palliation with chemotherapy and radiation, and aggressive surgical salvage. While surgery offers the only realistic chance at cure, this procedure is fraught with significant morbidity and a poor success rate. In an attempt to clarify the role of surgical salvage in these patients, experience with 57 patients with stomal recurrence presenting to three head and neck surgical groups will be presented. Forty-one of these patients subsequently underwent definitive surgery. The overall 2-year survival for operated patients was 16% with a 24% determinate survival. Further analysis revealed a 45% 5-year survival with type 1 and 2 lesions and 9% survival with types 3 and 4. Recommendations regarding indications for surgery are made based on this experience.

Carcinoma, Squamous Cell↗
PubMed1986

Photodynamic therapy. A viable alternative to conventional therapy for early lesion of the upper aerodigestive tract?

Photodynamic therapy (PDT) is a treatment modality that results in selective destruction of malignant cells by combining a photosensitizing agent (hematoporphyrin derivative), which is taken up by the cells, and a laser light. This therapeutic modality has been effectively used in managing cancers of the skin, bronchi, and bladder. In the head and neck area, however, its use has been confined to the palliation of advanced lesions that have proved refractory to conventional therapy. While this is unquestionably a valid role, its true therapeutic value may be in the management of early cancers arising in the upper aerodigestive tract. At the University of Cincinnati, PDT has been used on a variety of such early cancers where, for multiple reasons, conventional therapy was not possible. While no attempt will be made to comment on long-term survival or to compare PDT with more conventional therapeutic regimens, a preliminary experience with this modality in managing lesions of the larynx, oral cavity, and oropharynx will be presented. Apparent advantages, disadvantages, and pitfalls will be presented.

Aged↗
PubMed1986

Photodynamic therapy for early squamous cell cancer of the upper aerodigestive tract.

Photodynamic therapy (PDT) is a treatment modality that results in selective destruction of malignant cells by combining a photosensitizing agent (hematoporphyrin derivative), which is taken up by the cells, and a laser light. This therapeutic modality has been effectively used in managing cancers of the skin, bronchi and bladder. In the head and neck area, however, its use has been confined to the palliation of advanced lesions which have proved refractory to conventional therapy. While this is unquestionably a valid role, its true value, therapeutically, may be in the management of early cancers arising in the upper aerodigestive tract. At the University of Cincinnati, PDT has been used on a variety of such early cancers where, for a variety of reasons, conventional therapy was not possible. A preliminary experience with this modality in managing lesions of the larynx, oral cavity and oropharynx has demonstrated that this is a viable alternative.

Aged↗