Tumor heparanase expression in predicting response to induction chemotherapy in patients with locally advanced laryngeal cancer.

PURPOSE: Induction chemotherapy is a feasible alternative to surgery for the treatment of locally advanced laryngeal cancer. Determining predictive factors associated with a better response to chemotherapy would help choose the patients most likely to benefit from larynx preservation. METHODS: Eighty-four patients diagnosed with locally advanced laryngeal cancer (stage III-IV) between April 1999 and May 2006 were retrospectively reviewed. Eightytwo of them received 2 cycles and 2 received only 1 cycle of cisplatin and 5-fluorouracil (5-FU) chemotherapy. Patients were then grouped, based on response to treatment, as either having complete response (CR), partial response (PR), stable (SD) or progressive disease (PD). Factors predicting response to treatment were evaluated. Paraffin blocks were immunohistochemically examined for heparanase activity to see for any link between heparanase expression and response to treatment. RESULTS: There were 73 males and 11 females with a mean age of 59 years. After induction chemotherapy (cisplatin and 5-FU), 33 patients achieved PR and 20 CR. SD and PD occurred in 9 and 21 patients, respectively. Patients with stage III disease had better overall (CR and PR) response rates when compared with those with stage IV disease. Moreover, development of bone marrow suppression and heparanase positivity were both associated with better overall response rates. CONCLUSION: This study supports the hypothesis that heparanase positivity is associated with better responses to induction chemotherapy, regardless of TNM stage. Furthermore, a higher overall response rate was observed in patients who developed myelosuppression secondary to chemotherapy.

Prognostic significance of depth of invasion in cancer of the larynx.

To determine the prognostic significance of depth of invasion in laryngeal cancer, the depth of invasion of tumor was measured with an ocular micrometer on the laryngectomy specimens of 94 surgically treated patients with T1, T2, and T3 laryngeal cancer and was expressed in millimeters. There was a significant negative correlation between the depth of invasion and disease-free survival. The tumors with no clinical involvement of regional lymph nodes in neck (NO neck) had significantly less depth of invasion than those with involvement (N+ neck). The tumors with pathologically confirmed cervical lymph node metastasis had significantly more depth of invasion than those without metastasis. For tumors with a depth of invasion equal to or greater than 3.25 mm, the rate of cervical metastasis in this study has always been significantly higher than for those with a depth of invasion less than 3.25 mm (P < .05). The mean depths of invasion for cases with and without recurrence were not significantly different. According to the multivariate analysis, depth of invasion (P = .047) and patient age (P = .113) significantly affected the disease-free survival independently. The depth of invasion did not significantly affect the recurrence and the interval between surgery and the development of recurrence (P > .15). The depth of invasion should be measured in every laryngectomy specimen. The depth of invasion influences the cervical metastasis and disease-free survival significantly but does not affect the recurrence rate. The depth of invasion plays an independent role in determining the disease-free survival.

Detection of head and neck cancer with 99Tc(m) glutathione: a correlative study with tissue glutathione and glutathione S-transferase levels.

In this study glutathione (GSH), a natural tripeptide which plays an important role in detoxification reactions, protecting cells against damage from xenobiotics, has been labelled with 99Tc(m) for the demonstration of head and neck cancer. Twenty-eight patients (10 females and 18 males) with various malignancies of the head and neck were given 740 MBq of 99Tc(m)-GSH intravenously and single-photon emission computed tomography (SPECT) images were obtained at 3 h. Semiquantification was performed by drawing regions of interest on three consecutive transaxial slices and tumour to background ratios were calculated. In addition, GSH and glutathione S-transferase (GST) levels were measured in the tumour samples and in normal tissue which were obtained during surgery. Scintigraphic images showed that there was increased uptake in the tumour compared to the normal contralateral side (tumour/normal tissue (mean +/- SD) = 1.94 +/- 0.76). The tissue analyses revealed increased levels of GST in tumour tissues, but both GST and GSH levels in tumour were not statistically different from those in the normal tissue. We conclude that scintigraphic visualization of head and neck tumours can be attributed to increased demand for GSH in cancer. Protein binding might account for the prolonged retention of 99Tc(m)-GSH in the malignant tissue. Like other peptides, it is accumulated and excreted by the kidneys, which allows clear visualization of the abdomen without interference from gastrointestinal system activity.

Synovial sarcoma in the neck.

Synovial sarcomas are very uncommon and highly malignant tumours. This uncommon malignant tumour of mesenchymal origin may rarely present in the neck. Since 1954, nearly 80 cases of synovial sarcoma, located in the head and neck region have been reported. Synovial sarcoma is most prevalent in adolescents and young adults between 15 and 40 years of age. In this report we present a case of synovial sarcoma in the neck of a 10-year-old patient.

Giant sphenoid sinus. A case report.

A rare case of giant sphenoid sinus with excessive pneumatization is presented. The relevant literature is discussed.

Primary gingival leiomyosarcoma.

A case of primary gingival leiomyosarcoma in a 64-year-old woman is presented. The treatment modalities are discussed and the previous literature is reviewed.

How I do it: closure of tracheoesophageal puncture site.

BACKGROUND: Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, tracheoesophageal fistulas occasionally need to be closed, usually at the request of the patient, because of leakage through an enlarging fistula. We present our technique for closure of tracheoesophageal fistula. METHODS: An incision is made at the mucocutaneous junction of the stoma from the 9 to the 3-o'clock position. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The esophageal mucosa is closed with inverted sutures. After multiple layer closure of the esophageal fistula, the tracheal mucosa is closed with everted sutures. RESULTS: This technique has been used in nine patients. Eight were successful. The remaining patient had radiation therapy failure. CONCLUSION: This method of closure is simple and effective for those patients who require permanent closure of the tracheoesophageal fistula.

Mediastinal obstruction of the trachea.

Acute tracheal obstruction by a mediastinal mass is uncommon in otolaryngologic practice. Choosing techniques for securing the airway, induction of anaesthesia, and the surgical approach require careful deliberation. We report our experience in a patient with acute respiratory distress due to external compression of the trachea in the mediastinum by metastatic carcinoma. We used a fibre-optic bronchoscope ensheathed by an endotracheal tube to secure the airway. Standard tracheotomy tubes were too short to splint open the obstruction in the distal trachea, whereas the long Montgomery T-tube was effective.

Wolfram (DIDMOAD) syndrome: a multidisciplinary clinical study in nine Turkish patients and review of the literature.

AIM: To study Wolfram syndrome (WFS) with multidisciplinary consultations and compare the results with the literature. METHODS: Nine patients fulfilled the ascertainment criteria of WFS (insulin-dependent diabetes mellitus and optic atrophy). All patients were evaluated by the departments of paediatrics, ophthalmology, audiology, urology and medical biology. RESULTS: The earliest manifestation of WFS was insulin-dependent diabetes mellitus (at a median age of 6.9 y), followed by optic atrophy (8.9 y), diabetes insipidus (10.2 y) and deafness (10.5 y). Short stature was found in five cases, delayed puberty in two cases and hypergonadotropic hypogonadism in one case. Audiography disclosed hearing loss at high frequency in all patients (100%), but only five patients had clinical subjective hearing problems. Intravenous pyelography revealed hydroureteronephrosis in eight patients. Urodynamics revealed a normal bladder in only one patient. Three patients had a low-capacity, low-compliance bladder, detrusor external sphincteric dyssynergia and emptying problem, while five had an atonic bladder. Ocular findings were optic atrophy, low visual acuity and colour vision defects. Visual field tests revealed concentric and/or peripheral diminution in five patients. Visual evoked potentials were abnormal (reduced amplitude to both flash and pattern stimulation) in seven patients. Cranial magnetic resonance imaging showed mild or moderate atrophy of the optic nerves, chiasm, cerebellum, basal ganglia and brainstem in six patients; there was a partially empty sella in one case. There was no evidence of mitochondrial tRNA(Leu) (UUR) A to G (nucleotide 3243) mutation. CONCLUSION: Wolfram syndrome should be evaluated in a multidisciplinary manner. Some specific and dynamic tests are necessary to make a more precise estimate of the prevalence and median age of the components of WFS. Short stature is a common feature in WFS. Hypogonadism may be hypogonadotropic or hypergonadotropic. Bladder dysfunction does not always present as a large atonic bladder in WFS. A low-capacity, high-pressure bladder with sphincteric dyssynergia is also common.

A rationale for the selection of nasal decongestants in lacrimal drainage surgery.

Adequate hemostasis during lacrimal drainage surgery affects the success of the operation. Nasal decongestants, which are sympathomimetric agents including sympathomimetic amines and imidazoline derivatives, help to decrease bleeding. Certain of the imidazoline derivatives--oxymetazoline and xylometazoline--are potent and long-acting agents that have many of the same adrenergic effects as cocaine. Their use as an alternative to cocaine provide adequate hemostasis with less adverse reactions than cocaine. The authors recommend premedication of the nasal mucosa with oxymetazoline or xylometazoline before lacrimal drainage surgery for obtaining maximal nasal mucosal decongestion.