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Biomedical subjects

W J Mann

Publications and source records attributed to W J Mann.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Treatment of cavernous hemangiomas with the neodymium:YAG laser].

BACKGROUND: Cavernous hemangiomas are benign vascular lesions which are apparent at birth or soon thereafter. Although hemangiomas involute spontaneously, cosmetically unacceptable results or life-threatening complications may occur, necessitating early therapy. METHODS AND PATIENTS: Thirty-four patients with facial cavernous hemangiomas were treated with a cw-neodymium:YAG laser. Before, during, and after the treatment the skin was cooled with ice. The quartz fiber was used in contact or non-contact technique, and in very large hemangiomas we used interstitial treatment. RESULTS: In all patients a clear reduction of the tumor size was achieved. In 26 cases the tumor disappeared completely. Usually there is considerably swelling of the tumor immediately after treatment which decreases within some days. Side effects include local hyperemia and slight burns. Scarring was seen in only two cases. CONCLUSIONS: Facial cavernous hemangiomas can be treated satisfactory by the neodymium:YAG laser. Safe, active intervention with this laser is possible in most, if not in all, cases and it provides an alternative to other treatment modalities including the neglect of these lesions.

Adolescent↗
PubMed1996

Hearing loss as a complication of stapes surgery.

During a 10-year period (1984-1994) 1229 stapes operations for otosclerosis were performed at our respective institutions by experienced surgeons well trained in the various techniques. Procedures included 691 stapedectomies, 234 small-fenestrae stapedotomies, and 304 revision operations. These primary and revision cases resulted in 20 ears with severe sensorineural hearing loss or anacusis noted during the immediate postoperative period. This article will critically evaluate those procedures that resulted in profound hearing loss and attempt to determine possible reasons for this occurrence. It is hoped that these data will allow surgeons to identify before and/or during surgery patients at risk for development of this complication and therefore decrease the overall morbidity rate of this exacting procedure.

Adolescent↗
PubMed1996

Heterogeneity of squamous cell carcinomas of the head and neck--analysis of tumor biologic factors and proliferation rates.

Specimens obtained from five different tumor regions in 12 patients who underwent surgery for squamous cell carcinoma (SCC) of the oropharynx were examined. The evaluation of each biopsy included quantitative DNA measurements based on image analysis, immunohistochemical assessment of proliferations markers (i.e., Ki67-MIB1, proliferating cell nuclear antigen [PCNA]), and morphological tumor-front grading. From single cell measurements, several DNA indices were derived which are known to reflect tumor aneuploidy. The results revealed a marked variation of proliferation and cellular differentiation in different regions of tumors and a wide intraindividual variation between particular tumors for all markers examined. There was good correlation between DNA data and proliferative cell fractions (Ki67 score, PCNA score). With the use of diagrams, three-dimensional distribution of proliferation rates and markers reflecting tumor aggressiveness within each tumor was obtained. The results confirmed previous clinical and histological observations that SCCs of the oropharynx are heterogeneous tumors. One might expect that the regions with increased proliferation and aggressiveness may predict the location of possible tumor recurrence.

Biomarkers, Tumor↗
PubMed1996

Laparoscopic cholecystectomy for recurrent gallstone pancreatitis during pregnancy.

A pregnant patient with gallstone-induced pancreatitis initially responded to medical treatment, but the pancreatitis recurred. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy were done at 28 weeks' gestation. The remainder of the pregnancy was unremarkable. Although 20 cases of laparoscopic cholecystectomy have been reported for cholecystitis during pregnancy, this is the first report of laparoscopic management of recurrent gallstone pancreatitis in a pregnant patient.

Adult↗
PubMed1995

Studies for estimating the biologic behavior and prognosis of paragangliomas in the head and neck.

Despite a large number of histopathologic and immunohistochemical studies, the biologic behavior and prognosis of paragangliomas (glomus tumors) of the head and neck still remain uncertain. In the present study 36 specimens from 32 patients who underwent surgery for a paraganglioma were examined. The examinations included routine histology, quantitative DNA analysis based on image cytometry, immunohistochemical detection of the proliferating cell nuclear antigen (PCNA) along with visualization of nucleolar organizer regions (AgNOR). According to LeCompte, the paragangliomas were histologically divided into three subcategories: 16 patients had a paragangliomatous tumor. 14 patients had an adenomatous tumor, and 6 patients had an angiomatous tumor. Quantitative DNA analysis revealed three categories of tumors with characteristical DNA pattern; DNA type I tumors were pure diploid, DNA type II tumors had stemlines at 2c and 4c and were therefore recognized as diploid-tetraploid. Aneuploid cells were not apparent in these two groups. DNA type III tumors had stemline ploidies exceeding 2c and 4c. Aneuploid cells were present in all of these tumors. The biologic behavior of these lesions therefore must be recognized as suspicious. DNA type III tumors and adenomatous tumors showed the highest values for the PCNA scores, indicating a higher proliferation rate and a more rapid growth pattern in these lesions. Twenty patients could be followed over a period of up to 110 months. Five of these patients developed a recurrent tumor. All of them had DNA type III tumors. The DNA indices showed significantly higher values in the recurrent tumor group. The 2c deviation index (DI) and the entropy value had the highest prognostic significance. No correlation to clinical follow-up was found for the AgNOR score. Based on these results, prognostic indices for paragangliomas were developed: patients with a tumor having a 2c DI exceeding 2.0, entropy value of more than 4.0. 5c exceeding rate more than 8.0, and a PCNA score more than 20.0% can be recognized as being at high-risk for developing recurrent disease.

Journal Article↗
PubMed1995

Intraoperative monitoring of motor cranial nerves in skull base surgery.

Intraoperative monitoring of cranial nerves is performed to minimize postoperative cranial nerve dysfunction. We performed electrophysiologic monitoring of motor cranial nerves with a NIM 2 unit from Xomed Treace and a patient multiplexer developed in our clinic. This multiplexer allows simultaneous monitoring of four cranial nerves and is additionally equipped with a bipolar stimulation mode. This intraoperative monitoring was used during 102 skull base operations. Of these, 44 operations were acoustic neuroma removals by translabyrinthine approach and 36 by a middle fossa approach. Various operations, including removal of tumors of the jugular foramen and the infratemporal fossa, were performed in the remaining 22 patients. The facial nerve, being the most frequently monitored nerve, was evaluated both preoperatively and intraoperatively. Electrophysiologic data were evaluated with respect to their predictive value for postoperative facial nerve function. The relative percent decrease in amplitude of the electromyogram after resection compared to that observed before resection seems to be of some predictive value for the postoperative facial nerve function. A 50 to 60% decrease or more is associated with an increase in the House classification. Intraoperative monitoring is a useful tool in skull base surgery, allowing for safer and faster identification of motor nerves in pathologic-anatomic conditions. It allows the surgeon a degree of comfort by providing immediate information regarding the status of the nerve. It may also improve postoperative nerve function and shorten operating time. Additionally, neuromonitoring provides some information about expected postoperative facial nerve function.

Journal Article↗
PubMed1995

A phase II study of fazarabine (NSC 281272) in patients with advanced squamous cell carcinoma of the cervix. A Gynecologic Oncology Group study.

Promising preclinical data and reasonable toxicity in Phase I trials encouraged the Gynecologic Oncology Group to study Fazarabine (FZB) in patients with recurrent squamous cell cancer of the cervix. Twenty-three patients with histologically proven recurrent cervical cancer with measurable disease received FZB at a dosage of 30 mg/m2 per day for 5 days; cycles repeated every 28 days. In the absence of grade 3 or 4 toxicity, dose escalation was planned to a maximum dose of 40 mg/m2 per day for 5 days. All patients were evaluable for toxicity. Seven patients developed neutropenia; in two instances, it was considered life-threatening. The only other serious adverse effect was seen in one patient who developed grade 4 nephrotoxicity. Nineteen women who had failed prior chemotherapy were evaluable for response. There were no complete or partial responses; and seven had stable disease. Fazarabine exhibits no demonstrable activity in this patient population at the dose and schedule tested and further clinical trials as second-line chemotherapy are not warranted.

Adult↗
PubMed1995

Predicting recurrence and survival in patients with laryngeal cancer by means of DNA cytometry, tumor front grading, and proliferation markers.

The cure rates for squamous cell carcinoma of the larynx have improved little over the past few decades. Despite the large number of therapeutic and histopathologic studies that have been performed, there are currently no morphologic or cytologic markers available to predict outcome in patients with laryngeal cancer. In an attempt to create such a system, tissues from 40 patients who underwent surgery for carcinoma of the larynx were examined for this pilot study. The examinations included routine histology, morphologic grading at the tumor front, immunohistochemical identification of the proliferation markers proliferating cell nuclear antigen (PCNA) and Ki67, and quantitative DNA analysis. By means of the stepwise multivariate Cox regression analysis with forward selection, factors that were highly correlated to the development of recurrent disease and survival were determined. We found that the results of the DNA analysis (ie, 2c deviation index, DNA malignancy grade), along with the morphologic tumor front grading and Ki67 score, were closely related to prognosis (p < .01). All of these factors reflect tumor biology. No correlation was found for the Broders grading or for any other clinical parameter. With the test battery used in this preliminary study, patients at high risk for developing tumor recurrences could be recognized. The advantages of this technique are that it is an objective assessment of the tumor and that it can be performed on preoperative biopsy specimens. This might influence decisions regarding therapeutic management and could eventually lead to more appropriate and individualized therapy.

Biomarkers, Tumor↗
PubMed1995

Respiratory epithelium exposed to sulfur dioxide--functional and ultrastructural alterations.

The value of morphological investigations of airway mucosa should be compared to a functional method when estimating the toxicity of airborne pollutants. In 34 guinea pig tracheas, mucociliary activity was measured using a modified light beam reflex method before and following exposure to sulfur dioxide for 30 minutes in concentrations ranging between 7.5 and 37.5 mg/m3. Exposure to air served as a control. Simultaneously, specimens were taken for light and electron microscopy. Mucociliary activity decreased from 8.4 +/- 2.9 Hz (control exposure) to 4.0 +/- 2.9 Hz following exposure to 7.5 mg/m3, to 3.4 +/- 2.7 Hz at 15 mg/m3 sulfur dioxide, to 1.8 +/- 2.2 Hz at 22.5 mg/m3 sulfur dioxide, to 1.5 +/- 1.8 Hz at 30 mg/m3 sulfur dioxide, and to 2.0 +/- 1.2 Hz at 37.5 mg/m3 sulfur dioxide, respectively (P < .01). Despite a 56% decrease in mucociliary activity, only minor morphological alterations were observed following exposure to 7.5 mg/m3 sulfur dioxide. However, following exposure to 15 mg/m3 sulfur dioxide or higher, structural alterations of respiratory mucosa such as epithelial sloughing, intracellular edema and mitochondrial swelling, widened intercellular space, and ciliary cytoplasmic extrusions were found. Thus measurement of mucociliary activity proved to be a more sensitive indicator of airway toxicity than structural investigations alone.

Animals↗
PubMed1995

Ability of visual tests to predict underlying cervical neoplasia. Colposcopy and speculoscopy.

OBJECTIVE: To describe the attributes of colposcopy and a low-power, magnified examination that utilizes chemiluminescent illumination (speculoscopy) in the visualization of cervical epithelium in a predefined, high-risk population and to compare how the two tests predict cervical histology. STUDY DESIGN: During this multicenter, prospective study, 395 women who were referred to our colposcopy clinic underwent a repeat cervical smear and speculoscopy followed immediately by colposcopy. Abnormal colposcopic lesions were biopsied and endocervical curettage performed when indicated. Histologic diagnoses were compared with cytology, speculoscopy and colposcopy results. RESULTS: Colposcopy was more sensitive than speculoscopy in the detection of cervical neoplasia (97% vs. 82%) (P < .001) and was superior in visualizing focal lesions and vascular patterns. An antecedent acetowhite abnormality detected during speculoscopy was highly predictive of subsequent abnormal colposcopy (97% positive predictive value). The "overall" rate of acetowhite lesions during speculoscopy was nearly half the rate during colposcopy (P < .001). CONCLUSION: Colposcopy is better suited than speculoscopy to the follow-up of patients with abnormal cervical cytology because it facilitates lesion grading and assists in directing biopsies. Speculoscopy is best utilized as a dichotomous screening test based on the presence or absence of at least one well-demarcated acetowhite lesion and may be more suitable than colposcopy as an adjunct to cervical cancer screening due to its lower overcall rate. The biophysical properties of blue-white chemiluminescent light as it relates to the diagnosis of cervical neoplasia are discussed.

Adult↗
PubMed1994

Diagnosis and management of epithelial cancer of the ovary.

Epithelial ovarian cancer is a lethal disease that is asymptomatic in the early stages and a diagnostic problem even in an advanced stage. Aggressive cytoreductive surgery ("debulking"), followed by intensive multiagent chemotherapy, offers the best chance of cure or prolonged survival. "Second-look" surgery is appropriate for select patients, and radiotherapy may be useful in a small number of patients. Terminal care focuses on nutrition support, pain control and symptomatic management of recurrent ascites and bowel obstruction.

Carcinoma↗
PubMed1994

Pterional/Lateral approach to orbital tumors.

The purpose of this article is to detail our experience with an approach to primary pathologic conditions involving the orbit. In 27 patients these included tumors of the lacrimal gland, lymphangiomas, neurinomas, meningiomas, and various cysts of the orbit. Access to these lesions was gained by a lateral pterional approach with osteoclastic or osteoplastic removal of the lateral bony wall/roof of the orbit, and by entering adnexal contents following elevation of the lateral rectus muscle. This approach allowed for complete tumor removal in all patients. The specifics of this approach will be discussed and associated orbital complications will be detailed.

Journal Article↗
PubMed1994

Petrous apex lesions.

The purpose of this article is to detail our experience in treating 69 patients over the past 6 years with pathologic processes involving the petrous apex. These included 25 (36%) primary petrous apex lesions, 40 (58%) lesions that involved the petrous apex by direct invasion from an adjacent region, and four (6%) lesions that were the result of metastatic spread from a distant site. Although lesions of the petrous apex are uncommon, they may present significant morbidity to the patient. The symptoms elicited by these lesions are usually vague and nonlocalizing in the early stages but may progress to include multiple cranial neuropathies. Successful results are contingent on early diagnosis, which requires a high index of suspicion and use of appropriate imaging modalities. Thorough preoperative assessment with use of computed tomography, magnetic resonance imaging, and carotid arteriography is essential to plan the surgical approach. We present this collection of patients in order to aid in the further preoperative characterization of the differences in primary and secondary lesions of the petrous apex.

Journal Article↗
PubMed1994

Perforation of a Meckel's diverticulum caused by ingestion of a coin.

A 25-year-old woman ingested a quarter. Three days later, lower abdominal pain, fever, chills, and physical findings compatible with pelvic inflammatory disease developed. Radiographic examination showed the coin in the middle pelvis. Persistent abdominal complaints, abnormal physical examination, and failure of the coin to progress through the gastrointestinal tract despite conservative management led to surgical intervention. Exploration revealed an inflammatory process in the posterior uterine culde-sac with multiple omental, small bowel, and uterine adhesions due to perforation of a Meckel's diverticulum. Excision of the Meckel's diverticulum was done, and the patient recovered satisfactorily.

Adult↗
PubMed1994

Comparison of cytophotometric characteristics to histology and proliferation markers in acoustic neuromas.

Specimens of histologically confirmed acoustic neuromas obtained during operation in 25 patients were examined. Quantitative DNA measurements were performed with an image analysis system. From the single cell measurements, the mean DNA content of all tumor cells, 2c deviation index (2c DI), DNA entropy, DNA grade of neoplasia, and percentage of tumor cells with a DNA content of more than 5c (5c exceeding rate) were derived, as well as the mean nuclear area of the tumor cells. Proliferating cell nuclear antigen (PCNA) was identified immunohistochemically. A PCNA score was developed in determining PCNA-positive cells in a total amount of 1,000 cells. Results of quantitative DNA measurements and PCNA scores were compared to clinical symptoms, histology, and time between first onset of symptoms and diagnosis of the tumor. Quantitative DNA measurements revealed the existence of hyperdiploid tumor cells in all neuromas. According to the frequency with which they occurred, tumors could be divided into two categories: 1) tumors with a high percentage of hyperdiploid cells ("hyperdiploid tumors") and 2) those with a low percentage ("diploid tumors"). Hyperdiploid tumors showed increased values for the 2c DI, mean DNA content, DNA grade of neoplasia, and DNA entropy as signs of increased proliferation. In addition, the PCNA scores were higher in these tumors, indicative of increased DNA synthesis. The mean nuclear area was higher in these tumors. No correlation was found between the results of the DNA analysis and the PCNA score, or the clinical data and the predominant histologic subtype.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed1994

Ultrasonography for evaluation of the carotid artery in head and neck cancer.

The dynamic relationship of lymph node metastases to surrounding vascular structures in the neck is important for preoperative patient assessment. When carotid artery involvement is suspected, this relationship often determines whether or not to operate. In the case of adhesive neck metastases along the internal jugular vein, it becomes possible to predict preoperatively if the integrity of this vein may be preserved. Ultrasonography has the ability to differentiate subtle from gross adherence, or simple compression from vascular invasion. This is done by manually palpating the tumor mass and asking the patient to perform various maneuvers while observing on a monitor the relationship of the tumor mass to the nearby artery. This article correlates the preoperative computed tomography/magnetic resonance imaging (CT/MRI) and ultrasound findings in 41 patients with large nodal metastases which were subsequently confirmed during surgery. In case of positive ultrasonographic invasion of the carotid artery, a transcranial Doppler ultrasonography (TCD) exam was performed to confirm adequate crossflow. Our experience with ultrasonography and TCD in patients with suspected involvement of the carotid artery shows reliable results and obviates in our hands the routine need for more complex, invasive, and expensive tests.

Carotid Arteries↗
PubMed1994

An in vitro model to study effects of airborne pollutants on human ciliary activity.

A method to study the effects of airborne pollutants on ciliary activity of isolated human respiratory cells is presented. Human respiratory cells were scraped from nasal cavities of 25 healthy volunteers and washed in Ringer's solution. The cells were placed on polycarbonate membranes (3 microns pore size) and kept in macroplate holders swimming on Ringer's solution. Cells were thus kept humid and were supplied with nutrients through the pores of the membrane by capillary forces, while their surface was exposed to the gaseous environment. Isolated respiratory cells were exposed to SO2, NO2, and mixtures of SO2 and NO2 in various concentrations for 30 min and for 2 h. Exposure to synthetic air served as control. Ciliary beat frequency was measured using video-interference contrast microscopy, before and after exposure to the various gases. Exposure of isolated respiratory cells to a non-toxic gaseous environment resulted in a 20% reduction of ciliary beat frequency. A concentration-dependent decrease of ciliary beat frequency following exposure to SO2 in concentrations ranging between 2.5 and 12.5 ppm was found. Exposure to NO2 up to 2 h in concentrations ranging between 3 ppm and 15 ppm did not decrease ciliary beat frequency. No cumulative effect was found, if a mixture of SO2 (2.5 ppm) and NO2 (12 ppm) was applied.

Adult↗