Tunable plasmonic nanobubbles for cell theranostics.

Combining diagnostic and therapeutic processes into one (theranostics) and improving their selectivity to the cellular level may offer significant benefits in various research and disease systems and currently is not supported with efficient methods and agents. We have developed a novel method based on the gold nanoparticle-generated transient photothermal vapor nanobubbles, that we refer to as plasmonic nanobubbles (PNB). After delivery and clusterization of the gold nanoparticles (NP) to the target cells the intracellular PNBs were optically generated and controlled through the laser fluence. The PNB action was tuned in individual living cells from non-invasive high-sensitive imaging at lower fluence to disruption of the cellular membrane at higher fluence. We have achieved non-invasive 50-fold amplification of the optical scattering amplitude with the PNBs (relative to that of NPs), selective mechanical and fast damage to specific cells with bigger PNBs, and optical guidance of the damage through the damage-specific signals of the bubbles. Thus the PNBs acted as tunable theranostic agents at the cellular level and in one process that have supported diagnosis, therapy and guidance of the therapy.

Sinus surgery combined with antifungal therapy is effective in the treatment of invasive Aspergillus sinusitis in neutropenic patients with cancer.

BACKGROUND: Invasive Aspergillus sinusitis (IAS) is associated with high mortality and poor response to antifungal therapy in patients with hematologic malignancies (HM). PATIENTS AND METHODS: We identified 353 patients with invasive aspergillosis of whom 39 patients had IAS. Of the 39 patients, 13 underwent sinus surgery (SS) in addition to the antifungal therapy, and the remaining 26 control patients received antifungal therapy alone. Most patients with IAS had underlying leukemia (85%). Both groups had comparable clinical characteristics such as gender, age, underlying disease, neutropenia at the onset, persistent neutropenia, graft-vs-host-disease, and comparable antifungal therapy. RESULTS: Overall response was 7 (53.2%) in the SS group vs 5 (19.2%) in the control group (p = 0.06). Among the subgroup of patients with neutropenia at the onset of infection, the response rate in the SS group was significantly better than in the non-SS group (57% vs 11.8%, respectively; p = 0.028). CONCLUSION: In neutropenic patients with IAS and underlying HM, SS significantly improved the response to antifungal therapy. Additional studies are warranted.

A randomised clinical trial of nicotine patches for treatment of spit tobacco addiction among adolescents.

BACKGROUND: This study tested the efficacy of nicotine patches in combination with behavioural therapy for the treatment of adolescent spit tobacco addiction. Prior interventions had resulted in mean cessation rates below 15% at one year. METHODS: This study, the PATCH Project, used a three group, placebo controlled, randomised clinical trial design. The control group received a standard 3-5 minute counselling followed by a two week follow up phone call. The two intervention groups received a six week behavioural intervention; in addition, one group received active nicotine patches while the other group received placebo patches. Both groups received quarterly stage based telephone counselling. RESULTS: At one year, the usual care group's spit tobacco cessation rate was 11.4% (exact 95% confidence interval (CI) 6.1% to 19.1%), placebo patch 25.0% (95% CI 16.9% to 34.7%), and the active patch 17.3% (95% CI 10.4% to 26.3%). When both patch groups were combined, the cessation rate was 21.2% (95% CI 15.7% to 27.6%). The cessation rates for active and placebo patch were not significantly different (exact two sided p = 0.22), while the combined patch groups had a significantly greater cessation rate than usual care (exact two sided p = 0.04). CONCLUSIONS: The behavioural intervention proved to be about twice as successful as previous interventions, but the nicotine patch offered no improvement in cessation rates. The behavioural intervention is based on publicly available materials and can be easily adapted for widespread use, particularly in high schools.

Intranasal glomangioma.

Glomangiomas of the nasal cavity are a rare occurrence. Only 9 cases of this vascular tumor have been reported in the literature. A case of intranasal glomangioma is reported with a review of pertinent literature. The histogenesis, clinical presentation, diagnosis, immunohistochemical features, and treatment of these rare tumors are presented.

Risk factors for local recurrence of adenoid cystic carcinoma: the role of postoperative radiation therapy.

PURPOSE: Postoperative radiation therapy is often advocated in the treatment of patients with adenoid cystic carcinoma (ACC) of the head and neck. A retrospective analysis was performed to determine prognostic factors for local recurrence after surgery and to examine the role of postoperative radiation therapy. MATERIALS AND METHODS: A retrospective analysis of 58 patients undergoing surgery for ACC of the head and neck at the University of Pittsburgh Medical Center from 1974 to 1994 was performed. Patients were followed up for a minimum of 24 months for the development of recurrent disease. The association of recurrence was correlated with clinical factors (age, sex, site, and stage); postoperative treatment (radiation therapy v no radiation); and pathologic variables (grade, margins of resection, and perineural invasion), and appropriate statistical analysis was performed. RESULTS: Recurrent disease developed in 59% of patients, despite the addition of postoperative radiation therapy in 83% of patients. Tumor site was the single most important factor for the development of locally recurrent disease and was correlated with primary tumor stage and resection margins. Local recurrence rates were decreased (P = .07) in patients with negative surgical margins who were irradiated. CONCLUSIONS: Larger perspective randomized trials are necessary to evaluate the efficacy of postoperative radiation, and new treatments need to be investigated to improve local control rates for ACC of the head and neck.

Cytologic findings in thyroglossal duct carcinoma.

Approximately 150 cases of thyroglossal duct carcinoma, predominantly of the papillary type, have been reported, but the preoperative fine-needle aspiration (FNA) diagnosis of such neoplasms has rarely been cited. The authors describe FNA findings in four samples obtained from three patients who were 29, 50, and 83 years of age, histologically diagnosed as papillary (n = 2) and squamous (n = 1) thyroglossal duct carcinomas. Atypia and squamous cell carcinoma were the FNA diagnoses in the patients with papillary carcinomas. The remaining case was correctly diagnosed as keratinizing squamous cell carcinoma. Cellularity was scant in two cases and moderate in one, and all displayed a cystic background. The authors also reviewed FNA features in 11 papillary and 2 Hurthle cell carcinomas from the English language literature; diagnostic findings were present in less than one third of the cases. In conclusion, familiarity with the FNA findings of thyroglossal duct carcinoma is limited by its rarity. The presence of large, atypical squamous cells, or psammoma bodies, in the FNA material of a midline anterior cystic neck mass should suggest papillary thyroglossal duct carcinoma.

Subglottic cancer.

In summary, subglottic tumors are fortunately uncommon. They tend to present late with extensive disease, and are difficult to assess clinically. CT and MRI can be helpful in this regard. They have a tendency for extra laryngeal spread and paratracheal lymph node metastases. Aggressive surgical therapy is therefore recommended. This usually includes a wide field laryngectomy, an adequate low tracheal margin, and bilateral paratracheal lymph node dissection. The thyroid gland should be removed on the ipsilateral side, and if there is evidence of gross invasion of the thyroid gland, total thyroidectomy should be performed. Postoperative radiation therapy is recommended to both sides of the neck, stoma, and upper mediastinum. This will hopefully reduce the risk of stomal recurrence.

Serum tumor markers of head and neck cancer: current status.

The serum level of a variety of substances shows significant changes in head and neck cancer patients. Such substances are collectively called biochemical tumor markers. To date, most markers lack a high degree of specificity and sensitivity. However, serial measurement of markers showing elevated pretreatment levels may help in monitoring response to therapy. Other potential uses of tumor markers include earlier detection of recurrence and/or metastasis, and possible prediction of prognosis. Measurement of more than one marker seems to enhance the diagnostic accuracy of the test. Some markers show significant correlations with various immune parameters in head and neck cancer patients and may have a possible role in potentiating the immunodepressed status of such patients. A review of currently reported tumor markers in head and neck cancer showing their nature, sources, uses, and limitations is presented.