Search

Objective/hypothesis: We examined whether p53 gene mutations were predictive of clinical behavior in laryngeal cancer.Study Design: Retrospective study of 45 patients with laryngeal cancer from 1985 to 1997.Methods: DNA was extracted from tumor tissue and subject to polymerase chain reaction single-strand conformational polymorphism (PCR-SSCP) as well as DNA sequencing. The clinical outcome was correlated to the presence or absence of a p53 mutation.Results: The p53 gene was analyzed by direct DNA sequencing and was found to be mutated in 33% (15/45) of patients. The presence of a p53 mutation was associated with a significant improvement in overall survival (80% vs. 43%, P < .03) and a trend toward improved disease-free survival (87% vs. 60%, P = .08). When other prognostic factors were adjusted, multivariate analysis revealed a trend toward improvement in overall survival as well as disease-free survival.Conclusion: Depending on the location of a p53 mutation, the suppressive functions or clinical outcome may or may not be affected. Fifty-three percent of mutations were detected in nonconserved regions as opposed to 17% as reported in colon cancer. In colon cancer, mutations in conserved regions of the p53 gene predicted a poorer survival, whereas nonconserved gene mutations were not predictive. In our group of patients. p53 mutations predicted a better prognosis, which may be due to a large proportion of mutations that lie within nonconserved areas. The predictive power of p53 gene mutations may depend on functional loss and inactivation of highly conserved areas and must be tested in a prospective trial. [ABSTRACT FROM AUTHOR]

Objectives: The reconstructed pharyngoesophageal segment (PES) serves as the neoglottis following total laryngectomy, as it provides the source of vibration for production of tracheoesophageal puncture (TEP) voice. To date, little information exists regarding the vibratory characteristics of the PES. The purpose of this investigation was to study the anatomy and physiology of the PES using videostroboscopy.Study Design: Prospective study investigating the anatomy and physiology of the PES in 34 laryngectomees who used TEP speech as their primary form of communication.Materials and Methods: Videostroboscopy and voice recordings were graded by three trained, blinded judges using a seven-point scale.Results: The patients demonstrated differences that allowed for separation of patients into two main groups: "poor" and "effective" TEP speakers. The voice quality differences were explained by anatomic and physiologic characteristics of the PES. Redundant, thick, and dyssynchronous PES features were observed in patients with poor TEP speech skills; the effective speakers exhibited less redundant, thinner mucosa and more synchronous vibratory patterns. Moreover, the latter subgroup consistently demonstrated a greater degree of volitional PES control and less spasmodic activity than their poorly speaking counterparts. Length of the PES opening (measured in the horizontal plane) as well as amount and consistency of secretions did not appear to influence TEP speech or voice proficiency.Conclusion: Videostroboscopy in laryngectomees is a noninvasive, inexpensive, easily performed procedure that may contribute valuable information regarding the anatomy and physiology of the PES, especially in patients who experience difficulties achieving satisfactory TEP voice and speech production. [ABSTRACT FROM AUTHOR]

Increased mortality and arterial hypoxemia have long been associated with posterior nasal packs placed for control of severe epistaxis. Several authors have postulated a nasopulmonary reflex to partially explain this clinically observed phenomenon. In ten young, healthy subjects, using a multiparameter pulmonary evaluation, posterior nasal packs were placed and no significant changes were observed in lung volumes, flow and alveolar gas exchange, especially oxygenation. These findings suggest that aspiration, sedation, and degeneration of pulmonary function with age, not a nasopulmonary reflex, have not been adequately emphasized in previously performed studies. [ABSTRACT FROM AUTHOR]

Utilizing a multi-variate computer based analysis technique, the 1,400 case head and neck tumor registry of Washington University was examined for possible staging variables as an alternative to the current TNM system. Site, age, characteristics of surgical margins, and absence of neck node metastasis were identified as being predictive of nonrecurrence of cancer. A computer model utilizing the variables was compared to the current TNM system and found to be somewhat better (71.2% vs. 65.2%) in accuracy of prediction of nonrecurrence of cancer. Further analysis suggests that future improvements in predictive ability of the model will have to await the identification of new variables such as those that might arise from the current work in areas of flow cytometry or human stem cell cultures. [ABSTRACT FROM AUTHOR]

Basal cell carcinomas often exhibit aggressive and destructive behavior on the midface, with invasion into the orbit, paranasal sinuses, and even the frontal fossa. Minor modifications in surgical procedures for cosmetic considerations may have devastating consequences on the patient's survival. Tumor extirpation should not be compromised by preoperative planning of the method of reconstruction to be used. Margin control intraoperatively with either conventional frozen sections or the fresh tissue Mohs technique is mandatory for success. If any margin is questionable, reconstruction should be delayed at least until permanent sections confirm complete tumor removal. Ten cases are presented and the literature reviewed to emphasize that inadequate initial management probably contributes more to the observed destructiveness of these lesions than histologic aggressiveness or embryologic patterns of the midface. [ABSTRACT FROM AUTHOR]