Biomedical subjects
Publications and source records attributed to S Handler.
We report the MR results of four patients with plexiform neurofibromas of the larynx. Three had irregular margins and were circumferential around the airway. The distinction between regularly and irregularly shaped neurofibromas may have implications for symptom onset.
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Twenty children with soft tissue sarcomas of the head and neck, treated at the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania from 1972 to 1981, were evaluated for the late deleterious effects of treatment. All patients received radiation therapy and combination chemotherapy with vincristine, dactinomycin, and cyclophosphamide; certain patients also received Adriamycin (doxorubicin). All had ophthalmologic, otologic, growth, and cosmetic evaluations; 15 also had dental and maxillofacial examinations. The median age at diagnosis was 6 years (range, 7 months-13 years). Median follow-up from time of diagnosis was 5.5 years with a minimum of 3 years in all but four patients. The major problems encountered were related to the eyes (xerophthalmia and cataracts), ears (hearing loss), teeth (maleruption and caries), glandular structures (xerostomia, hypopituitarism), and development (craniofacial deformity). It is concluded that children treated for soft tissue sarcomas of the head and neck with combined modality therapy, including radiation enhancers, may show a variety of late treatment-related adversities. These children require close multidisciplinary follow-up for detection of late effects in order that appropriate prophylactic or symptomatic treatment can be instituted to minimize their consequences.
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Thirty-two children aged three months to 17 years (median six years) were diagnosed with soft-tissue sarcoma of the head and neck and treated at the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania from 1971 to 1981. Thirty-one received chemotherapy and all received radiation therapy (RT). Twenty-five patients had pre-treatment computed tomography (CT) scans, which were used for staging and treatment planning. Doses of radiation therapy ranged from 3000 to 7300 rad to the primary tumor (median 5000 rad). The overall five-year survival of the entire group of 32 patients was 75%. Ten of the 32 patients had invasive cranial parameningeal disease as demonstrated by bony erosion at the skull base, seen on CT in eight and plain radiographs in two patients. Eight of these 10 patients have developed recurrent sarcoma: four in the meninges, two locally, one regionally and one distantly. Five of these 10 children with invasive cranial parameningeal sarcoma received 3000 rad of prophylactic cranial irradiation, begun within the first 12 days of chemotherapy, and none developed meningeal disease. In contrast, only one of the 22 patients without invasive cranial parameningeal disease has relapsed (local recurrence). The data suggest that soft-tissue sarcomas of the head and neck in children without invasion into the base of the skull (invasive cranial parameningeal disease) are usually cured. CT scans are essential for staging. Patients with invasion of the base of the skull may be protected from meningeal relapse by early cranial irradiation, although they still are at high risk for relapse in other sites.
Most of the serious organic diseases of the colon are etiologically linked to the high-saturated-fat and low-fiber Western diet. Benign but common conditions, such as appendicitis and diverticular disease of the colon, appear to be due to deficiency of fiber and attendant low-bulk stools. Colon cancer appears to be due to carcinogens created in the colon itself. Contributing to carcinogen production are cocarcinogens in bile and an increase in anaerobic bacteria, both directly related to high levels of saturated fat in the diet. If these common disorders of the colon are to be controlled, our diet will require major modification. Changes will have to include reduction of saturated fats of animal origin and increase in cereal grains.
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Thirty children with clinical evidence of otitis media underwent tympanocentesis. Streptococcus pneumoniae was the predominant organism recovered (63%). Three cases of Hemophilus influenzae, alone or in combination with S pneumoniae, were identified. Other organisms found were Staphylococcus albus, Neiserria species. Group A B-hemolytic Streptococcus, and anaerobes. In four patients (13%) no organism was recovered. All isolates were ampicillin susceptible. No relationship was found between WBC, temperature, or age and the organism recovered. Tympanocentesis did not provide any information resulting in an alteration of therapy. Tympanocentesis may be indicated for relief of pain or for periodic surveillance of organism sensitivities, but is not justified in the emergency department for uncomplicated acute otitis media. [Friedman A, Fleisher GR, Henretig F, Handler S, Campos JM: Otitis media: Update on etiology and management. Ann Emerg Med 11:181-183, April 1982.]
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The clinical course of 130 patients treated for malignant parotid tumors at the three institutions have been reviewed. Fifty-six of these 130 patients developed recurrences following their primary treatment by a surgical procedure. There were a total of 109 recurrences among these 56 patients. The average number of recurrences was two per patient. The average survival from first recurrence was 3.7 years, with the median survival 2 years. The range of survival was 0.5 to 17 years. Once recurrence developed, treatment was by surgery, radiation therapy, chemotherapy, or a combination. Of 56 patients with recurrence, 33 are dead and 9 patients are alive with disease. Fourteen patients are alive and well with no evidence of disease. These NED patients had an average number of 1.6 recurrences and a median survival to date of only 3 years. Our study indicates that for the majority of patients who develop recurrence, survival is relatively short and treatment is usually ineffective in three of four patients. The authors conclude that after a surgical procedure for malignant salivary gland tumors, a trial of wide field postoperative radiation therapy to high dose should be considered as part of the initial treatment.
Saliva and serum electrolyte concentrations were monitored in 30 patients given a course of xerostomia-producing cancer radiotherapy. The mean flow rate of stimulated whole saliva decreased 83.3% during a 6-week treatment period. The striking reduction in saliva output was accompanied by significant increases in saliva Na+, Cl-, Ca++, Mg++ and Prot.- concentrations and by a decrease in saliva HCO3- content. The xerostomic saliva was more concentrated and had a greater salinity than the pretreatment saliva in each instance. In contrast, none of the serum electrolytes measured was significantly altered by the subtotal salivary shutdown.
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