The p53 tumour suppressor gene is activated following cellular exposure to DNA‐damaging agents. The functions of wild‐type p53 protein include transient blocking of cell cycle progression, direct or indirect stimulation of DNA repair machinery and triggering of apoptosis if DNA repair fails. Therefore, the status of p53 protein may be critically associated with tumour cell radiosensitivity. In the present study we examine the intrinsic radiosensitivity of 20 human carcinoma cell lines derived from 15 patients with different types of head and neck tumour. Radiosensitivities were measured in a 96‐well plate clonogenic assay in terms of the mean inactivation dose, surviving fraction at 2 Gy, and constants α and β in the linear quadratic survival curve. The p53 allele status was determined by amplifying exons 4–10 by the polymerase chain reaction (PCR), screening for mutations using single‐strand conformation polymorphism (SSCP) analysis and determining the exact type and location of a mutation by direct sequencing. The results showed that prevalence of p53 mutations in squamous cell carcinoma (SCC) cell lines is high (80%), and that deletion of one or both wild‐type alleles is common (75%). Intrinsic radiosensitivity of the cell lines varied greatly in terms of mean inactivation dose, from 1.4±0.1 to 2.6±0.2 Gy. Radiosensitivity correlated well with the p53 allele status so that cell lines carrying a wild‐type p53 allele were significantly ( P <0.01) more radioresistant (mean inactivation dose 2.23±0.15 Gy) than cell lines which lacked a wild‐type gene (1.82±0.24 Gy). Evaluation of our own results and those published in the literature lead us to conclude that absence of the wild‐type p53 allele in human head and neck cancer cell lines is associated with increased radiosensitivity. However, the sensitivity is also strongly dependent on the exact type and location of the p53 mutation.
Objectives: We evaluated the results of cases of chronic otitis media treated with mastoid obliteration surgery using bioactive glass S53P4. Methods: Twenty-five patients with chronic otitis media and 1 patient with cerebrospinal fluid leakage without chronic infection were treated with bioactive glass S53P4. Twenty patients had had previous surgery because of chronic otitis media with or without cholesteatoma. A mastoid obliteration was performed with bioactive glass S53P4 granules and a musculoperiosteal flap with or without bone paté. In 2 patients with a bony dehiscence at the middle cranial fossa, a bioactive glass plate was used to support the protruding dura. In addition, in 3 patients, occlusion of a dural fistula was needed. The median follow-up period was 34.5 months (range, 1 to 182 months). Results: Excluding the 2 patients with only 1 month of follow-up at our department, 96% of the patients had a dry, safe ear or only intermittent otorrhea. In 92% of the patients, the objective of achieving a smaller or nonexistent cavity was achieved. Conclusions: Bioactive glass S53P4 is a noteworthy material in mastoid obliteration surgery.
Spectral gradient acoustic reflectometry (SGAR) and tympanometry are handy methods to aid in the diagnostics of middle-ear diseases, but no prior studies have directly assessed the correlation between SGAR and tympanometry readings in children.We compared SGAR and tympanometry in 2152 otoscopic examinations among 600 children aged 0.6-14 years, who were examined for signs and symptoms of respiratory infection in a primary care setting; 677 (31.5%) of the ear examinations were in children <3 years of age. We further determined the test characteristics of these methods for the detection of middle-ear effusion (MEE) using pneumatic otoscopy as the gold standard. All examinations were performed by trained physicians.SGAR and tympanometry indicated probable absence of MEE in 1896 (88.1%) and 1937 (90.0%) of the 2152 ears, respectively. SGAR levels 1-2 were observed in 95.7% of ears with type A/As tympanogram and in 58.1% of ears with type B tympanogram. The frequency of type B tympanogram increased with increasing SGAR levels, from 4.8% at SGAR level 1 to 67.7% at SGAR level 5. The observed agreement between the 2 methods was 86%. The test characteristics of SGAR and tympanometry for the detection of MEE diagnosed by pneumatic otoscopy were comparable.The high specificities and negative predictive values of SGAR and tympanometry make them useful aids particularly in ruling out MEE in children with respiratory infections. The low cost, easy portability and absence of need for an airtight seal support the use of SGAR also for screening purposes at home.
AbstractCervical metastasis of unknown origin is still a challenging problem because of its relatively poor prognosis and the uncertainty regarding the primary site. We analyzed retrospectively all 72 patients with cervical metastases of unknown origin, diagnosed and treated between 1985 and 1995 in the five university hospitals of Finland in order to analyze survival rates and some prognostic and clinical factors of the disease. The most common sites where the primary tumor was found during follow-up or at autopsy were the lung (8%), the oral and pharyngeal region (7%) and the skin (6%). When the lower neck nodes (regions IV-VI) were affected, the primary tumor was significantly ( p <0.001) more often found from the subclavicular sites. The disease-specific 5-year survival rate was 32%. In multivariate analysis, nodal stage N2c or N3 [adjusted relative hazard of death (HR) 2.43], other metastases found at the time of treatment (HR 2.15) and age>65 years (HR 2.12) were significantly associated with a poor prognosis. Median survival tended to be longer for patients treated with surgery combined with radiotherapy (39.9 months) compared with those treated with radiotherapy alone (16.8 months), but this difference was not statistically significant ( p =0.153).KeywordsCervicalMetastasisPrimarySitePrognosticFactorsSurvivalTreatment
Many head and neck cancer patients suffer from poor nutrition. Nutrition is a problem during and after therapy, especially when it consists of extensive surgery, intensive (chemo)radiotherapy or their combination. Additional enteral nutrition has been provided by means of either nasogastric tube feeding, surgical gastrostomy, radiologic percutaneous gastrostomy or percutaneous endoscopic gastrostomy (PEG). Because of the straightforward, easy technique involved and its low complication rate, PEG has become established as the primary route of nutrition in these patients. Previously, the aim of assisted enteral nutrition was to compensate for already existing malnutrition; nowadays, an additional purpose is to diminish or prevent the development of malnutrition. The main objective of this study was to evaluate the safety of pre-treatment PEG in a sample of patients with an upper aerodigestive tract area malignancy treated in a tertiary referral centre.A total of 79 patients with an upper aerodigestive tract area malignancy were treated with a total of 80 PEGs during the period 1997-2001.Most of the PEGs (62/80; 77.5%) were performed by an otolaryngologist. An open gastrostomy was needed in five cases because of unsuccessful gastroscopy due to oesophageal stricture (n=4) or severe trismus (n=1). Both acute and late complications were minor and the respective complication rates (1/80; 1.3% and 12/80; 15%) were low. In addition, all complications were easily managed and did not seriously affect the actual treatment.A major advantage of having the PEG performed by the otorhinolaryngologist was the possibility to combine it easily with other necessary procedures, such as panendoscopy, tracheostomy and additional biopsy. In addition, the timing of the procedure was easy to schedule.
Abstract OBJECTIVES Tracheobronchial stenting has an established role in the palliation of malignant central airway obstruction (CAO). The purpose of this study is to describe the experience with self-expanding metal airway stents in 2 tertiary referral centres, covering a third of the population of Finland. METHODS Patients referred to and treated with airway stenting for malignant CAO using self-expanding metal-stents were identified from electronic patient records, and data were collected using a structured Endoscopic Lower Airway Management instrument. Statistical analysis to reveal factors affecting patient benefit and survival was carried out. RESULTS A total of 101 patients (mean age 65.8) and 116 procedures were identified. Procedure-related mortality was rare (3/101 patients) and complications infrequent. The median survival was 2.3 months [95% confidence interval (CI): 1.4–3.1). Stent benefit was not significantly affected by clinical characteristics. Survival was impacted by the use of adjunct procedures [hazard ratio (HR) 0.36, 95% CI: 0.23–0.58, P < 0.001), procedural urgency (HR 0.40; 95% CI: 0.23–0.71, P = 0.002) and post-treatment chemoradiotherapy (HR 0.29, 95% CI: 0.15–0.56, P < 0.001). CONCLUSIONS The beneficial impact observed supports the further use of tracheobronchial stenting in malignant CAO. The use of self-expanding metal stents is encouraged.
