Squamous cell carcinoma of the pyriform sinus

This is a review of 418 patients with cancer of the pyriform sinus who had complete treatment at University of Texas M. D. Anderson Hospital, treated over a 28-year time span. Treatment modalities used included radiation therapy, surgery, and planned combined treatment, primarily in the form of surgery and postoperative radiation therapy. Superficial lesions, with no impairment of laryngeal motility, are suitable for irradiation therapy planned for cure. (The policies of treatment have changed throughout the years). Analysis is made comparing the results of the larger groups of patients treated by surgery only, or surgery followed by postoperative radiation therapy. There is a significant lower incidence of failure above the clavicle in the combined treatment group, and a better 5-year survival. Rate of recurrences and the specific sites of failure above the clavicles are discussed, as well as the means of preventing such. The causes of death between 2 and 5 years are presented.     

Ten-year survival in 290 patients with endometrial cancer: prognostic factors and therapeutic approach

Summary. Between 1970 and 1976, 290 patients with endometrial cancer were treated at the 1st Obstetrics and Gynecology Clinic of the University of Milan. The median age was 62 years. Surgery was completed in 262 (90.3%) patients. Abdominal hysterectomy was used in 158 (70.9%) stage I and 40 (71.4%) stage II/III patients; vaginal hysterectomy in 55 (24.7%) stage I and nine (16.1%) stage II/III patients. Resection of the upper vagina was performed in 168 patients. Postoperative external beam radiotherapy was used in stage II/III patients and in 44 (19.7%) stage I high-risk patients. Ten-year survival, determined by the life-table method, was 84.8% in stage I (223 patients), 53.4% in stage II (37 patients), 64.4% in stage III (19 patients), and 9.1% in stage IV (11 patients). Factors associated with poorer prognosis were: late age at diagnosis (P<0.001); deep myometrial invasion (P<0.001); poorly differentiated histological grade ( P =0.11); lack of resection of the upper vagina ( P = 0.13). The role and importance of surgery is discussed, with special emphasis on the selective use of the vaginal route in aged, obese and medically high-risk patients.     

Estrogen receptors in normal salivary gland and salivary gland carcinoma

To access for possible hormone dependence, 19 samples of normal salivary gland tissue and 14 samples of salivary gland carcinoma were quantitatively analyzed for estrogen receptor (ER) content. A receptor protein content of greater than or equal to 1 fmol/mg of cytosol protein was considered positive. Ten (77%) of 13 histologically normal samples, and four (80%) of five tumor samples obtained from male patients contained ER by this criterion, as did five (83%) of six normal samples and eight (88%) of nine tumor samples obtained from female patients. Mean ER concentrations plus or minus SE in male-derived samples were 2.02 +/- .42 fmol/mg of cytosol protein for normal tissue and 4.35 +/- 1.5 fmol/mg of cytosol protein for tumor tissue; mean ER concentrations in female-derived samples were 3.48 +/- 1.1 fmol/mg of cytosol protein for normal tissue and 12.64 +/- 6.4 fmol/mg of cytosol protein for tumor tissue. Four of eight tumors in women had levels considered to be "hormonally dependent" in breast carcinoma. These findings indicate that salivary gland carcinomas may be hormone-dependent.     

Superselective intra-arterial chemotherapy of advanced paranasal sinus tumors

Twenty-four patients with advanced paranasal sinus tumors were treated with combined superselective intra-arterial and systemic chemotherapy, yielding an immediate satisfactory tumor response rate of 91%, significantly better than previously reported. Eight patients had craniofacial surgery circumvented because of complete or near complete response. Repetitive uncomplicated catheterization of the pterygoid segment of the internal maxillary artery using a coaxial system is the cornerstone of successful induction chemotherapy. Strenuous screening of medical status is mandatory for this aggressive introduction chemotherapy.     

Economic costs of functional dyspepsia

Dyspepsia is defined as chronic or recurrent symptoms believed to originate in the upper gastrointestinal tract. When routine investigation results in no identifiable explanation for those symptoms patients are labelled as having functional dyspepsia. In community-based surveys, approximately 30% of the otherwise apparently healthy population report dyspeptic symptoms and the majority are believed to have functional dyspepsia. Although only 1 in 4 or 5 patients make use of healthcare resources, this patient category is one of the largest in ambulatory care (1.6 to 5% of all consultations in general practice). The annual frequency of consultations for functional dyspepsia in Sweden has been estimated at 47 per 1000 population. In consequence of its high prevalence and associated absenteeism, the total costs of functional dyspepsia are considerable. In Sweden in 1981, the costs were estimated at $US55 000 per 1000 population ($US113 630 in 1991 dollars). The most cost-effective management strategy remains to be defined. Evidence is accumulating that the traditional 'wait-and-see' policy with initial empirical therapeutic trials without investigation may not be the most cost conserving strategy.     

Sinonasal myxoma: a pediatric case

The authors report a case of a rare facial myxoma arising from the maxillary sinus in a 20-month-old child. The diagnosis was confirmed by a biopsy, and the patient underwent a partial maxillectomy to achieve a total resection of the mass due to the locally aggressive nature of the lesion. Myxomas should be differentiated from malignant sarcomas, in particular embryonal rhabdomyosarcoma, which can arise from the same location and require multimodality therapy consisting of surgery, irradiation, and chemotherapy.     

Arterielle Pulskonturanalyse zur Messung des Herzindex unter Veränderungen der Vorlast und der aortalen Impedanz

ZusammenfassungHintergrund Die arterielle Pulskonturanalyse wurde zur Bestimmung des Herzindex (CI) sowohl bei herzchirurgischen als auch bei kritisch kranken Patienten während unterschiedlichen klinischen Bedingungen validiert. Der anhand der Pulskonturanalyse bestimmte Herzindex (CI_PC) zeigt eine gute Übereinstimmung mit dem durch arterielle (CI_TD) oder durch pulmonalarterielle Thermodilution (CI_PA) bestimmten Herzindex. Die Genauigkeit der Pulskonturanalyse unter Bedingungen des offenen Thorax mit Veränderungen der Vorlast und der aortalen Impedanz ist jedoch unklar. Daher wurden CI_PC, CI_TD und CI_PA in Abhängigkeit dieser Veränderungen durch Sternotomie verglichen.Methodik 28 Patienten während elektiver koronarer Bypassoperation wurden untersucht. CI_PC und CI_TD, sowie CI_PA bei 6 Patienten, wurden vor sowie nach Sternotomie bestimmt, und die relativen Veränderungen CI_PC und CI_TD und CI_PA berechnet.Ergebnisse Die Sternotomie resultierte bei 25 von 28 Patienten in einem signifikanten Anstieg des CI. Eine Regressionanalyse wurde zwischen CI_PC und CI_TD vor bzw. nach Sternotomie (r² = 0,87, p<0,0001, r² = 0,88, p<0,0001) sowie zwischen CI_PC und CI_PA, vor bzw. nach Sternotomie (r² = 0,85, p<0,0001, r² = 0,93, p<0,01) und zwischen CI_PC and CI_TD (r² = 0,72, p<0,0001) durchgeführt. Eine Bland Altman-Analyse ergab für Bias (m) und Grenzen der Übereinstimmung (2SD) zwischen CI_PC und CI_TD vor und nach Sternotomie sowie zwischen CI_PC und CI_TD: m = –0,03 l/min/m², 2SD = –0,34 bis 0,28 l/min/m², m = –0,06 l/min/m², 2SD = –0,45 bis 0,33 l/min/m² und m = –0,02 l/min/m², 2SD = –0,47 bis 0,44T l/min/m². Schlussfolgerung Veränderungen der Vorlast und der aortalen Impedanz während Sternotomie beeinflussen nicht die Genauigkeit der arteriellen Pulskonturanalyse. CI_PC, CI_TD, und CI_PA zeigen unter diesen Bedingungen eine gute Übereinstimmung.     

La asociación entre metaplasia intestinal de la unión esofagogástrica y enfermedad for reflujo gastroesofágico en el Instituto Nacional de Cancerología

Introduction

Intestinal metaplasia in the oesophagus-gastric junction can originate in the distal oesophagus causing oesophagus-gastric reflux, or in the proximal portion of the stomach. This pre-malignant lesion can progress to cancer.

Objective

To determine the frequency of intestinal metaplasia of the oesophagus-gastric junction in patients with clinical gastric-oesophageal reflux and to evaluate the relationship with the chronic gastritis andHelicobacter pylori infection.

Material and Methods

Between March 2000 and June 2001, all patients who were referred to the Service of Endoscopy, without a diagnosis of cancer of the digestive tract and who, according to the Carlsson-Dent questionnaire, were classified as having oesophageal-gastric reflux were included in the study. Conventional endoscopy was performed and biopsies were obtained from the oesophagus-gastric junction. The pathologist who evaluated the samples was blinded with respect to the clinical details of the patients.

Results

The patients (n=51) included 20 men and 31 women, with a mean age of 53,7 years. The junction type was squamous-columnar in 30 patients and heterotopic “Z” type in 21. There were 17 patients with hiatus hernia and 12 with acute oesophagitis. Endoscopy indicated 6 patients with acute gastritis, 19 with chronic gastritis and 5 cases of Barrett's oesophagus. Histology indicated 3 patients with Barrett's oesophagus, 48 with chronic gastritis, 12 with cardial metaplasia and 34 withHelicobacter pylori infection.

Conclusions

Twelve (23.5%) patients presented intestinal metaplasia. In 66.6% there wasH. pylori infection and 48 patients (94.1%) had chronic gastritis. Endoscopically, the more frequent squamous-columnar junction was the heterotopic type in 58.8% with the type “Z” in 41.2% of patients.     

Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth

OBJECTIVE: To estimate the relationship between maternal periodontal disease and both early spontaneous preterm birth and selected markers of upper genital tract inflammation. METHODS: In this case-control study, periodontal assessment was performed in 59 women who experienced an early spontaneous preterm birth at less than 32 weeks of gestation, in a control population of 36 women who experienced an early indicated preterm birth at less than 32 weeks of gestation, and in 44 women with an uncomplicated birth at term (>or = 37 weeks). Periodontal disease was defined by the degree of attachment loss. Cultures of the placenta and umbilical cord blood, cord interleukin-6 levels, and histopathologic examination of the placenta were performed for all women. RESULTS: Severe periodontal disease was more common in the spontaneous preterm birth group (49%) than in the indicated preterm (25%, P =.02) and term control groups (30%, P =.045). Multivariable analyses, controlling for possible confounders, supported the association between severe periodontal disease and spontaneous preterm birth (odds ratio 3.4, 95% confidence interval 1.5-7.7). Neither histologic chorioamnionitis, a positive placental culture, nor an elevated cord plasma interleukin-6 level was significantly associated with periodontal disease (80% power to detect a 50% difference in rate of histological chorioamnionitis, alpha = 0.05). CONCLUSION: Women with early spontaneous preterm birth were more likely to have severe periodontal disease than women with indicated preterm birth or term birth. Periodontal disease was not associated with selected markers of upper genital tract inflammation. LEVEL OF EVIDENCE: II-2