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Jochen A Werner

Publications and source records attributed to Jochen A Werner.

53 records · Page 3Linked to original sources
PubMed2003

Laser surgical treatment of laryngeal paraganglioma.

Paragangliomas are rare benign neoplasms arising from the neural crest-derived paraganglia of the autonomic nervous system. In the larynx three different localizations of paraganglia are known. Most laryngeal paragangliomas arise from the supraglottic paraganglia. A review of the literature shows that the treatment of choice for laryngeal paragangliomas is surgical excision. Since the implementation of CO(2) laser surgery into laryngology in 1972, no reports of endoscopic laser surgical excisions of laryngeal paragangliomas have been published so far. We present the case of a 66-year-old female patient who suffered from a large (4 x 4 x 3 cm) left supraglottic paraganglioma. The tumour was completely excised utilizing the CO(2) laser. Histopathology and immunohistochemistry of the tissue presented the typical findings of a laryngeal paraganglioma. The pre- and post-operative management as well as the treatment strategies are discussed. To our knowledge the present case demonstrates for the first time a complete transoral CO(2) laser surgical resection of an advanced laryngeal paraganglioma.

Aged↗
PubMed2003

Optimal treatment of vascular birthmarks.

Optimal functional and cosmetic outcomes for vascular lesions require a thorough preoperative diagnosis of vascular anomalies, since correct classification of each vascular lesion has a direct influence on the treatment of choice. Many different classification systems have been discussed controversially. Based on clinical practicality and significant accuracy of forecast with regard to the clinical course of a lesion, Mulliken and Glowacki's biologic classification gained most clinical relevance and has become accepted as the official classification scheme by the International Society for the Study of Vascular Anomalies (ISSVA). Based on comprehensive description of relevant literature results, the current communication shall give an overview of differing, internationally accepted treatments. Although conservative management can be proposed for uncomplicated hemangiomas occurring in infancy, the proliferative progression of these lesions provides an adequate indication for treatment, while vascular malformations, which usually persist throughout life, always require therapeutic intervention if they start to cause clinical symptoms. Based on individual parameters (such as diameter, location and growth dynamics), different treatments, including cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgery, and/or embolization, can be performed successfully. Currently, however, none of these treatments represents the solitary treatment of choice.

Arteriovenous Malformations↗
PubMed2002

The role of intratumoral therapy with cisplatin/epinephrine injectable gel in the management of advanced squamous cell carcinoma of the head and neck.

OBJECTIVE: To determine the safety and efficacy of targeted antitumor therapy with cisplatin/epinephrine injectable gel in patients with advanced squamous cell carcinoma of the head and neck. DESIGN: Two prospective, double-blind, placebo-controlled phase III trials of identical design. Crossover from blinded to open-label phase was permitted for patients with disease progression. SETTING: Tertiary referral centers in North America and Europe. PATIENTS: One hundred seventy-nine intensively pretreated patients with recurrent or refractory squamous cell carcinoma of the head and neck. INTERVENTION: Cisplatin/epinephrine injectable or placebo gel was administered by direct intratumoral injection; up to 6 weekly treatments. Dose was 0.25 mL of active or placebo gel per cubic centimeter of tumor up to 10 mL total. Patient benefit after local tumor control of the most symptomatic tumor was assessed by patients and physicians using the Treatment Goals Questionnaire. MAIN OUTCOME MEASURES: Local tumor response and patient benefit attributable to improvements in tumor-related symptoms. RESULTS: Combined results for the 178 patients with evaluable data in the 2 trials confirmed objective tumor responses in 35 (29%) of 119 patients, including 23 (19%) complete responses achieved with cisplatin/epinephrine gel, vs 1 (2%) of 59 for placebo (P<.001). Tumor response and patient benefit were significantly correlated (P=.006): 47% (17/36) of patients with target tumor responses achieved a rigorously defined benefit based on a prospectively selected treatment goal vs 15% (22/142) of nonresponders. CONCLUSION: Cisplatin/epinephrine injectable gel reduces tumor burden, ameliorates tumor symptoms, and provides a new therapeutic option for treating patients with squamous cell carcinoma of the head and neck.

Adrenergic Agonists↗
PubMed2002

Bacteria and pathogenesis of human salivary calculus.

The exact cause of salivary calculus formation is unknown and the aim of this study was to ascertain whether bacteria play a role. Sialoliths from nine patients with chronic obstructive sialadenitis of the submandibular gland were analysed. Bacterial gene fragments were amplified from DNA extracted from salivary calculi by means of polymerase chain reaction using a universal bacterial primer pair. Comparative 16S ribosomal RNA sequence analysis was used for identification. We detected and identified oral bacteria (predominantly Streptococcus species) in all samples. The present results suggest a potential role for bacteria in the etiopathogenesis of sialolithiasis.

Adult↗
PubMed2002

Jewelry-induced diseases of the head and neck.

The desire to modify a person's outer appearance is a phenomenon that can be traced back to the beginning of humankind. Body modifications have been practiced among all cultures around the globe to differing extents. The authors present medical complications through jewelry in a series of 35 consecutive patients. Patient charts were evaluated for age, gender, type and sequelae of injury, complications, and treatment results. The male-to-female ratio was 1:2.2. Most of the recorded complications were related to the new vogue of piercing, with the ear affected most commonly. Usually the complications were minor; however, 2 patients sustained disfiguring damage to their auricular cartilage as a result of high ear piercing, a child nearly asphyxiated on an aspirated earring, and 2 patients experienced severe dysphagia as a result of tongue piercing. The most severe complication was a lethal strangulation injury in a female patient whose necklace got trapped in the headrest of her car seat during a front-end collision.

Adolescent↗
PubMed2002

Chronic sclerosing sialadenitis of the submandibular gland is mainly due to a T lymphocyte immune reaction.

The aim of our study was to investigate the role of immunopathological processes in the pathogenesis of chronic sclerosing sialadenitis of submandibular glands (Küttner tumor). For this purpose, biopsy specimens from submandibular glands of 22 patients with the histological diagnosis of chronic sclerosing sialadenitis were analyzed. Paraffin-embedded tissues were immunostained for T-lymphocyte subsets (CD3, CD4, CD8), cytotoxic T cells (granzyme B), B cells (CD20, Ki-B3), and macrophages (Ki-M1P). Polymerase chain reaction and capillary electrophoresis were used to detect rearrangements of the T-cell receptor gamma chain and the CDRIII region of the immunoglobulin heavy chain. In all cases, abundant cytotoxic T cells were found, especially in close association with ducts and acini. T-cell receptor gamma chain rearrangements showed a monoclonal pattern in 6 cases (27.3%), an oligoclonal pattern in 8 (36.4%), and a polyclonal pattern in 8 (36.4%). The B-cell reaction was less pronounced and largely restricted to lymph follicles. Molecular analysis of immunoglobulin heavy chain revealed a polyclonal rearrangement in 17 cases (77.3%). In conclusion, there is an intimate relationship between the T-cell-dominated inflammatory infiltrate and acinar and duct cells. This, together with the frequent demonstration of monoclonal and oligoclonal populations of cytotoxic T cells and their histopathological behavior, suggests that chronic sclerosing sialadenitis may be the result of an immune process triggered by intraductal agents.

Adult↗
PubMedDate not supplied

Transoral laser microsurgery in carcinomas of the oral cavity, pharynx, and larynx.

BACKGROUND: Since the introduction of laser technology in the 1960s, use of the technique in treating laryngeal diseases has demonstrated several advantages over conventional resections in selected cases. METHODS: The authors review the published data on oncologic laser surgery for the treatment of head and neck carcinomas, and they also describe their own clinical experience with transoral laser surgery for the treatment of carcinomas of the oral cavity, pharynx, and larynx. RESULTS: Laser surgery has achieved a key position in minimally invasive treatment concepts in the ears, nose, and throat area, especially for the treatment of malignancies of the upper aerodigestive tract. The CO2 laser is the approach most commonly used. CONCLUSIONS: New and improved applications of laser therapy in the treatment of cancer are being explored. As more surgeons become experienced in the use of lasers and as our knowledge of the capabilities and advantages of this tool expands, lasers may play a larger role in the management of head and neck cancers.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Ki-S1--a prognostic marker for hypopharyngeal carcinoma with potential predictive value for response to chemotherapy.

BACKGROUND: It has previously been shown that the proliferative activity, determined by means of the monoclonal antibody Ki-S11 against the Ki-67 protein, is a significant prognostic factor for squamous cell carcinoma of the hypopharynx (SCCH). We now investigated the prognostic and the predictive impact of Ki-S1, a monoclonal antibody which detects an epitope of topoisomerase II alpha, another proliferation-associated antigen. MATERIALS AND METHODS: The proliferation index (PI) in terms of Ki-S1 immunolabeling was evaluated on tumor specimens from 131 patients with SCCH. Survival probabilities over an observation time of 72 months were calculated by Kaplan-Meier analysis. RESULTS: Patients with low PI (< or = 45%) had a significantly improved 5-year survival (33.2%) compared with patients with high PI (> 45%), of whom only 11% survived after 5 years (p = 0.001). Since there was no significant difference between the results obtained with Ki-S1 and Ki-S11, the present data confirm the prognostic significance of the proliferative activity in SCCH. CONCLUSION: Topoisomerase II alpha is also the target of many antineoplastic drugs and it has been proposed that its expression in tumor cells correlates with chemosensitivity. The high average topoisomerase II alpha content in SCCH therefore promises a good responsiveness to topoisomerase inhibitors. Because Ki-S1 directly measures cellular topoisomerase II alpha expression, it might be exploited not only as a prognostic indicator but also as a predictive marker for patients with SCCH.

Adult↗
PubMedDate not supplied

Comparison of surface HLA class I levels in squamous cell carcinoma cell lines of the head and neck.

BACKGROUND: Squamous cell carcinomas of the head and neck (SCCHN) are the most frequent malignancies in this region. Down-regulation of human leukocyte antigen (HLA) class I was found to be implicated in the immune escape of these tumors. MATERIALS AND METHODS: Cell surface expression levels of several HLA class I antigens were evaluated in 21 SCCHN cell lines utilizing FACS analysis. RESULTS: Expression levels of HLA-antigens varied significantly between the investigated cell lines. On average higher HLA-B27 expression levels were observed in cell lines from younger and female patients. CONCLUSION: Our data confirms down-regulation of HLA class I to be an important event in SCCHN. However, since several SCCHN cell lines also exhibited high HLA levels, other mechanisms than HLA down-regulation also need to be considered as a cause for disease progression. Further studies will be required to elucidate the potential role of HLA-B27 in SCCHN.

Adult↗
PubMedDate not supplied

S19-mRNA expression in squamous cell carcinomas of the upper aerodigestive tract.

BACKGROUND: The differential display method showed altered expression of ribosomal protein S19 gene in human head and neck squamous cell carcinoma (HNSCC) cell lines. MATERIALS AND METHODS: To verify these results, RT-PCR analysis was carried out in 18 HNSCC and 17 benign epithelial cell lines as well as 30 HNSCC and 8 reference tissue samples. In the HNSCC cells S19 mRNA expression was significantly reduced as compared to benign epithelial cells. RESULTS: Change of the S19 gene expression in surgical samples was detectable but not significant although the histopathological grading of the HNSCC biopsies correlated significantly with the S19 mRNA expression levels. The expression of ribosomal protein S6 and S14 genes were additionally analyzed using the same methods. CONCLUSION: High correlation was found between the expression of S6/S14 and S19 suggesting that changes in S19 gene expression might be the result of loss of ribosomes in HNSCC cells.

Adult↗
PubMedDate not supplied

Mucocutaneous telangiectases of the head and neck in individuals with hereditary hemorrhagic telangiectasia -- analysis of distribution and symptoms.

Telangiectases are a diagnostic clue of hereditary hemorrhagic telangiectasia (HHT, Rendu-Osler-Weber disease), but they are not specific to HHT. The characteristic features of telangiectases were studied in a group of 70 individuals with this disorder. The files, including photo and video documentation of these patients, were reviewed with regard to mucocutaneous vascular lesions. Telangiectases could be identified within the nasal mucosa in 90% of the HHT patients. Extranasal telangiectases were identified in descending order in the oral cavity, the facial skin, the hands, the auricles and the thorax. The vascular lesions showed considerable variation in size and shape, and on the nasal mucosa they were most commonly hemorrhagic. The earliest onset of cutaneous telangiectases was documented at the age of 6 years. Contrary to previous communications, more than 25% of patients had hemorrhages outside the nose. These hemorrhages were self-limiting in most cases. Prolonged hemorrhages requiring treatment were observed in 12% of cases. Such severe hemorrhages originated from telangiectases of the base of the tongue, the body of the tongue, the fingers and the skin of the supraclavicular fossa. We conclude that telangiectases occur at an earlier age than generally thought and are a hallmark of a serious disorder rather than a cosmetic problem.

Adolescent↗
PubMedDate not supplied

Morphology and distribution of nasal telangiectasia in HHT-patients with epistaxis.

BACKGROUND: Epistaxis in hereditary hemorrhagic telangiectasia (HHT; Rendu-Osler-Weber syndrome) is a frequent symptom that may be caused by a multitude of different genetic and epigenetic phenomena. This investigation analyzes the distribution of nasal telangiectasia in 21 patients with HHT. METHODS: The patients were examined for endonasal telangiectasia by videoendoscopy with rigid endoscopes; in addition, the anterior portion of the nose was examined under the operating microscope. The endonasal findings were recorded on videotape and then evaluated in the media laboratory. RESULTS: Morphology of the nasal telangiectasia showed wide variations: the vessels were shaped like spots, loops, or spiders or they clustered and resembled raspberries. Gender did not have an influence on the phenotype of telangiectasia, whereas advancing age correlated with a higher density of telangiectasia. Patients with an intact nasal septum exhibited the bulk of telangiectasia in the anterior nasal cavity but also on the middle turbinates, the floor of the nose, and within the valve area. Patients with septal perforations displayed the majority of telangiectasia around the edge of the perforations, on the floor of the nose, and on the turbinates. Scattered telangiectasia also could be found in the profound parts of the nasal cavity and in the nasopharynx, especially in patients with septal perforations. CONCLUSION: The shapes of endonasal telangiectasia in HHT patients are very heterogeneous; predilection sites could first of all be found within the anterior portion of the nose. Morphology and distribution of endonasal telangiectasia change as a result of therapeutic interventions, development of septal perforations, and with advancing age. Therefore, repeat endoscopies are recommended to assess the actual stage of the disease before epistaxis therapy.

Adolescent↗
PubMedDate not supplied

Cytokeratins 6 and 16 are frequently expressed in head and neck squamous cell carcinoma cell lines and fresh biopsies.

BACKGROUND: Cytokeratins (CK) are members of intermediate filaments, which are predominantly found in epithelial cells. Different types of epithelia are characterized by a distinct composition of CK. Recently immunohistochemical investigations demonstrated that, among others, CKs 6, 14, 16 and 17 are regularly expressed in benign stratified squamous epithelium of the head and neck as well as in squamous cell carcinoma of the head and neck (HNSCC) in contrast to CKs 1, 10 and 11, that were only rarely expressed in these tissues. MATERIALS AND METHODS: Total RNA was isolated from 15 primary cell lines derived from HNSCC and from 15 tissue samples of oro- and hypopharyngeal carcinomas obtained from surgery specimens. CK expression was evaluated by RT-PCR, Western blot analysis and immunohistochemistry. RESULTS: CK6 and 16 were found to be expressed in both groups at almost 100%. The expression level of CK14 remained constant (73%) in both groups, at the RNA and protein level. CK17 was more frequently present in tumour specimens than in HNSCC cell lines. The immunohistochemical results of the surgical tumour specimens confirmed the results of Western blot analysis. CONCLUSION: The presented results show high and stable expression rates for CK6 and CK16 in HNSCC. These results will serve as a basis for further investigations concerning the search for circulating tumour cells and micrometastases. In addition, we found that cytokeratin expression in HNSCC is different on the RNA level compared to the protein level.

Biopsy↗
PubMedDate not supplied

The relevance of adhesion molecules in the classification of squamous cell carcinoma of the head and neck.

BACKGROUND: Clinical studies have demonstrated increased serum levels of E-selectin, P-selectin and VCAM-1 in patients with squamous cell carcinomas, which correlate with expression in the primary tumour. For this reason, selectin expression may also support the diagnosis and be of prognostic value in squamous cell carcinoma of the head and neck (SCCHN). MATERIALS AND METHODS: Using immunohistochemistry, the expressions of E- and P-selectin and VCAM-1 in SCCHN were characterised and analysed. RESULTS: The expressions of E-selectin and VCAM-1 were increased. The magnitude of expression was unrelated to the location or size of the primary tumour. With increasing de-differentiation, the expression of E-selectin increased, whereas the number of cells expressing VCAM-1 was highly variable. In contrast, E-selectin and VCAM-1 expressions decreased with progressive metastatic disease. CONCLUSIONS: These data demonstrate that the expression patterns of E-selectin and VCAM-1 may depend on differentiation and lymphogenic metastatic disease in SCCHN, and suggest that these molecules may have a dual role, depending on the stage of tumour development. These findings support the hypothesis that expression of E-selectin and VCAM-1 may be initiated by the release of tumour necrosis factor-alpha (TNF-alpha) at an early stage of tumour development. In contrast, the decrease in selectin expression, observed as the metastatic disease progresses, may serve as a protective mechanism to prevent an influx of effector cells.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

The auricular VX2 carcinoma: feasibility of complete tumor resection.

BACKGROUND: The aim of the study was to test the feasibility of resection of VX2 auricular squamous cell carcinoma (SCC) in New Zealand White rabbits (NZW), its influence on the regional and distant metastases and the general prognosis. MATERIALS AND METHODS: In 71 NZW rabbits, successful in sano wide margin resection of auricular VX2 SCC was performed 7 days after tumor induction. The animals were sacrificed and examined for metastases after 6 weeks. RESULTS: Local recurrences occured in 7% of the animals. In 28.2% lymph node (LN) and in 15.5% distant metastases developed. Regional metastases presented in 100% of the animals with recurrence and in 22.7% of the RO animals (p < 0.001). Distant metastases presented in 80% of the animals with local recurrence and in 10.6% of the R0 animals (p < 0.001). Of the animals with local control, those with N+ had a significantly higher incidence of distant metastases (46.7%) compared to those with N0 (0%, p < 0.001). Local control and LN involvement were found to be important prognostic factors for early tumor-related death. CONCLUSION: The VX2 auricular model resembles head and neck (HN) SCC in humans morphologically, pathophysiologically and as a complex neoplastic disease. In the experimental setting it behaved similarly to the clinical situation of wait-and-see in N0 HNSCC patients. Tumoral microemboli present a possible mechanism for the development of recurrences.

Animals↗