Management of osteomas of the paranasal sinuses

Craniofacial osteomas are benign tumors of the skull base, often involving the paranasal sinuses. The frontal sinus is the most common site of involvement, followed by the ethmoid, maxillary, and sphenoid sinuses, respectively. The growth rate is very slow, and it may take many years for osteomas to become clinically apparent. The origin of these tumors has been ascribed to embryologic tissue maldevelopment, trauma, or infection. The tumors are hard and lobulated with an ivory-like appearance, often mixed with a coarse granular component. The bone is compact or cancellous, with vascular or connective tissue components. The complications of osteoma growth are obstruction of sinus ostia, extension into adjacent bones and the intracranial cavity, and displacement of anatomic structures. Management of uncomplicated sinus osteomas is controversial, since surgery involves serious potential risks. When surgery is performed, these tumors can be successfully managed via endoscopic, open, or combined techniques. This article reviews the clinical findings, diagnostic studies, and treatment of 16 patients with paranasal osteomas. The indications for surgical intervention are discussed.

Analysis of cellular and decellular allogeneic dermal grafts for the treatment of full-thickness wounds in a porcine model

BACKGROUND AND METHODS

The need for a reliable skin substitute to improve burn treatment has been long apparent. We have investigated the use of cryopreserved cellular and decellularized porcine allogeneic dermal grafts (CADGs or DADGs) in conjunction with an overlying thin split-thickness autograft (STSG) in a one-step technique. Control mirror-image wounds were treated with thin STSG alone. Autograft "take" rates and wound contraction were determined; biopsies were taken at weeks 2, 5, and 8, and blinded scar assessment was performed at week 10.

RESULTS

The percent take of autografts overlying CADGs or DADGs was comparable to that of control sites (83.0 +/- 8.3% vs. 81.1 +/- 11.5% for CADG vs. control; 93.2 +/- 7.6% vs. 90.2 +/- 11.1% for DADG vs. control). CADGs did not alter wound contraction or cosmetic outcome. By contrast, DADG treatment inhibited wound contraction (42.9 +/- 17.8% vs. 30.9 +/- 10.4% contraction for control vs. DADG at week 10; p < 0.017) and significantly improved cosmetic outcome in 10 of 12 paired wounds (p < 0.012).

CONCLUSION

CADGs and DADGs permitted simultaneous engraftment of an overlying thin STSG. Although CADGs had no effect on wound contraction and cosmetic outcome, DADGs significantly reduced wound contraction and improved cosmetic outcome of full-thickness wounds in a porcine model. The use of DADGs may represent a potential improvement in burn care.

[Effects of cytokines on somatostatin in nude mice bearing human renal cell carcinoma]

We studied the relationship between the production of SS and treatment with cytokines and a new method for the treatment of renal cell carcinoma. 4.4 x 10(6)RCC94616 cells were injected subcutaneously into the back of nude mice. Five groups with TNF, IL-2, rIFN, TNF + IL-2, TNF + rIFN and controls were randomly divided according to the mean diameter of experimental tumor. After the last injection of cytokines, 0.5-0.8 ml blood, 1g tumor tissue, para-tissue and normal tissue were havested respectively. Contents of SS were tested by radioimmunoassay. In the treatment groups with cytokines, the concentration of SS was changed, siginificantly increased in the TNF + IL-2 group (P < 0.01). The effect on distribution of SS by cytokines may also be mediated by the regulation of human immunity and antitumor activity. It may be suggested that the method of TNF + IL-2 + SS is best to treat renal cell carcinoma.

Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx

Squamous cell carcinoma of the hypopharynx remains a highly lethal disease. This article documents our experience with 132 patients undergoing surgical management of squamous cell carcinoma of the hypopharynx, of whom 80% received postoperative radiation therapy. Local-regional control was obtained in 61% of the patients. Five-year overall and disease-free survival rates were 30% and 41%, respectively. Prognosis was better in patients with limited disease: local disease permitting larynx-sparing surgery, N0/N1 clinical neck, and stage I/II/III disease. Cancer of the hypopharynx remains an aggressive entity associated with poor prognosis. Novel strategies stressing improved local-regional control with prevention of distant metastasis are warranted.

Characterization of novel cell lines from pleomorphic adenomas of the parotid gland established in a collagen gel system

The pathobiology of salivary neoplasms can best be studied in a model system that reflects the native state of the tumor. The present study describes the use of a three-dimensional collagen gel (organoid) system in which pleomorphic adenomas of the parotid gland were propagated in vitro. Five pleomorphic adenoma cultures were established as organoid gels and compared with touch-preparations or cryopreserved specimens of native tumor. The organoid cultures demonstrated normal DNA content, the expression of myoepithelial cell proteins, and the production of sulfated acid mucins; these cellular and secretory features mimicked those found in the archival specimens. Further, organoid cultures of pleomorphic adenoma could be initiated after monolayer culture, demonstrating that culture on a plastic support does not alter the nature of the cells. Development of an in vitro culture system that maintains the native state of pleomorphic adenoma is an important tool for studying the pathobiology of these tumors.

[Study of nitric oxide synthases, nitric oxide and tumor necrosis factor in different types of ascites]

The purpose of this study was to elucidate the clinical significance of nitric oxide synthases (NOS), nitric oxide (NO) and tumor necrosis factor (TNF) in different types of ascites. NOS, NO and TNF in ascitic transudates of 21 patients with liver cirrhosis, ascitic exudate of 32 patients with liver cirrhosis and carcinogenesic ascites of 19 patients were measured by Griess, ELISA and colorimetric methods. Compares to the value in ascitic transudate of 21 patients with liver cirrhosis, NOS (7.32 +/- 3.13 nmol.min-1.g-1), NO (15.4 +/- 7.6 mumol/L) and TNF (331.7 +/- 121.2 mumol/L) in ascitic exudate of 32 patients with liver cirrhosis were significantly higher (P < 0.01). The NO (10.7 +/- 3.2 mumol/L) and TNF (185.6 +/- 84.1 mumol/L) in carcinogenesic ascites of 19 patients were between those in ascitic exudates and those in ascitic transudates of patients with liver cirrhosis (P < 0.05 or 0.01). The NOS activity was highest in carcinogenesic ascites. The decrease of 24h urine volume in patients with cirrhosis was relative to the increase of NO level in ascites. Those suggested that measurements of NOS, NO and TNF in ascites are helpful in differential diagnosis of ascites. The separation between NO level and NOS activity in ascites indicates that the ascites is carcinogenesis.

Secondary pharyngeal myotomy for tracheoesophageal speech

Pharyngeal myotomy in the post-laryngectomy patient has been described to reduce pharyngoesophageal spasm and facilitate vocal rehabilitation and tracheoesophageal speech. This report describes the complications and speech outcomes in 22 consecutive patients who underwent a secondary pharyngeal myotomy. The patients were all drawn from a hospital clinic dedicated to voice rehabilitation after laryngectomies. Their ages ranged from 54 to 81-years-old with a mean of 64. Two patients suffered surgical complications--both had pharyngocutaneous fistulas which resolved with conservative management. One patient had an incomplete myotomy and was treated with injection of boulinum toxin in the pharyngeal plexus. This treatment resulted in good vocalization. Seventeen of 22 patients in the study were long-term TEP users, and all of these were judged to have good speech quality. Our experience with myotomy for TEP speech demonstrates that many patients with pharyngoesophageal spasm can benefit from the procedure and successfully phonate. There were several complications related to the procedure, but these were successfully managed conservatively and without long-term sequela. Pharyngeal myotomy as an adjunct to TEP is useful and effective in selected patients.

Tracheoesophageal puncture in irradiated patients

Tracheoesophageal puncture (TEP) with use of a voice prosthesis is widely accepted as an excellent method of postlaryngectomy vocal rehabilitation. Many patients with advanced cancer require postoperative radiotherapy (RT), while other cancer patients have been treated with RT as a primary treatment and come to laryngectomy for salvage. The influence of RT on outcome of the TEP procedure with respect to successful speech and potential complications has not been widely discussed. We retrospectively reviewed 77 consecutive cases of TEP in patients who had received RT and laryngectomy for laryngeal cancer. All cases had a minimum of 6 months of follow-up. All 77 patients were successful in obtaining speech with the TEP, and 75 (97%) continued to be TEP users thereafter. Eight patients (10%) developed complications in the course of treatment. There was no mortality. In selected patients, TEP after RT is a relatively safe and effective method of vocal rehabilitation.

Surgical access to tumors of the cervicothoracic junction

BACKGROUND

Surgical resection of tumors of the cervicothoracic junction is often problematic due to the limitations imposed by the thoracic cage and adjacent neurovascular structures. The majority of surgical approaches to this region have been designed with the intent of providing adequate exposure for vertebrectomy with tumor resection and vertebral column stabilization. These approaches do not provide adequate exposure for a heterogeneous group of tumors which also involve the cervicothoracic junction. We used a combined cervicothoracic surgical approach to determine its efficacy in tumor resection.

METHOD

Seventeen patients with a heterogeneous group of malignancies arising in a variety of soft tissues underwent combined cervicothoracic resection. The approach consisted of anterior cervical access, median sternotomy, and anterior thoracotomy.

RESULTS

Complete gross tumor resection was accomplished in all 17 patients, 15 of whom had negative microscopic margins. Extensive reconstruction was employed in 6 patients. Three patients received intraoperative brachytherapy implants and 5 patients received external-beam postoperative radiotherapy. Local tumor control was obtained in 12 patients, and 10 patients are currently alive, free of disease (median: 12 months; range: 3-47 months). There was no inadvertent sacrifice of neurovascular structures. The sternoclavicular joint was maintained in all patients. There were 4 major complications, and no perioperative mortality associated with the surgical procedure.

CONCLUSION

The combined "trap door" technique provides sufficient exposure for resection of cervicothoracic tumors. Surgery is performed with limited morbidity with the sparing of uninvolved neurovascular structures. The sterno-clavicular joint was maintained in all patients. Preliminary results using this approach for resections of tumors of the cervicothoracic junction are encouraging.

[Spiral shaped bacteria in the human gastric biopsy]

Biopsy specimens from the gastric mucosa of 149 patients who underwent gastroduodenal endoscopy for upper gastrointestinal complaints were studied by light microscopy and culture. Spiral shaped bacteria were detected in four of the specimens by smears with Gram stain. The positive rate was 2.68%, but these bacteria and HP did not grow in culture. The characteristic helical morphology of the bacteria appears to be similar to that of the bacteria found in the stomach of cats and dogs. And what of significance in these cases is the presence of spiral shaped bacteria in association with chronic gastritis.