Jussi Laranne

Salivary gland cancer in Finland 1991–96: an evaluation of 237 cases

Conclusion In this material consisting of various salivary gland carcinomas, stage I, male gender and age were the most powerful predictors of patient outcome. Objectives To retrieve the records of all salivary gland cancer (SGC) patients diagnosed in Finland between 1991 and 1996 and to evaluate the incidence, histological type and location of SGC, the treatment given and the outcome. Material and methods The records for all SGCs (n=286) diagnosed in Finland between 1991 and 1996 and reported to the Finnish Cancer Registry were retrieved. The histological re-evaluation and retrospective study involved 237 SGC patients. Results The study population consisted of 125 males and 112 females. The mean age was 59 years (males 61 years, females 58 years). Follow-up was at least 5 years. The commonest tumor location was the parotid gland (n=152; 64%), followed by the minor salivary glands (n=46; 19%), the submandibular gland (n=38; 16%) and the sublingual gland (n=1; 0.4%). The most frequent histological types of SGC were adenoid cystic carcinoma (n=65; 27%), mucoepidermoid carcinoma (n=45; 19%) and acinic cell carcinoma (n=41; 17%). Surgery, either alone or in combination with other treatment modalities, was used in 209 cases (88%). Radiotherapy was given to 136 patients (57%), 13 of whom (5%) did not undergo surgery. The 5-year overall survival rate was 56.5%, and for stages I–IV it was 78%, 25%, 21% and 23%, respectively (p<0.001; log-rank test). Of the commonest tumor types, the best 5-year relative survival rate was for patients with acinic cell carcinoma (96%), followed by those with mucoepidermoid (79%) and adenoid cystic carcinoma (74%).

Depth of invasion, tumor budding, and worst pattern of invasion: Prognostic indicators in early-stage oral tongue cancer

Oral (mobile) tongue squamous cell carcinoma (SCC) is characterized by a highly variable prognosis in early‐stage disease (T1/T2 N0M0). The ability to classify early oral tongue SCCs into low‐risk and high‐risk categories would represent a major advancement in their management.

Treatment of Lymphangiomas with OK-432 (Picibanil)

Purpose: To determine the efficacy of OK-432 sclerotherapy in the treatment of lymphangiomas. Methods: The treatment was begun for 14 patients with lymphangioma. The age range of the patients at the time of the first injection was from 10 months to 42 years. Eleven of the lesions involved the head and neck region, two the thorax and one was localized in the extremity. Prior to treatment all patients were investigated with either magnetic resonance imaging, computed tomography, ultrasound or a combination of these modalities. The injections were performed with ultrasound and/or fluoroscopic guidance. Eight patients received OK-432 as first-line treatment; five were treated after surgery and one after medical therapy. On average, 2.2 intracystic injections were performed per patient. Nine of the lesions were macrocystic and five were mixed lesions. Results: Eleven patients showed complete or marked response to the OK-432 sclerotherapy, two patients had moderate shrinkage of their lesions and only one patient showed no response to therapy. Macrocystic lesions showed the best response to therapy. Those patients who received OK-432 as first-line treatment showed complete or marked response. Conclusion: It was found that treatment of lymphangiomas with OK-432 was safe and effective.

OK-432 (Picibanil) therapy for lymphangiomas in children.

Abstract Lymphangiomas are benign, soft tumors that most often affect the head and neck area, usually causing marked cosmetic and functional problems. Treatment options include surgery and a large number of different sclerotherapy agents. Surgical treatment is challenging because of the need for complete excision. The risk of damage to surrounding structures or poor cosmetic results is high. Various sclerotherapy agents have been shown to have minimal effects on lymphangiomas. Their use has been associated with severe systemic, local and cosmetic side effects. OK-432 (Picibanil) is a new and promising form of sclerotherapy. An intracystic injection of OK-432 produces a local inflammatory reaction, which leads to resolution of the lesion. We have treated 11 pediatric lymphangioma patients with OK-432 with excellent results: complete regression in six, marked regression in four and no response in one case. Local swelling should be anticipated, especially when treating lesions near the upper airway. We found OK-432 injections to be safe and effective as a first line of treatment for lymphangiomas.

Cervical Metastasis of Unknown Origin: A Series of 72 Patients

Cervical 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).

Endovascular Treatment of Venous Malformations in Extremities: Results of Sclerotherapy and the Quality of Life after Treatment

Purpose: To evaluate the long‐term results of endovascular sclerotherapy in treating venous extremity malformations and to assess the quality of life after treatment. Material and Methods: Twenty‐four patients were included who had completed treatment with ethanol sclerotherapy and a minimum of one year observation period. Nineteen patients attended a clinical control. To evaluate the quality of life after treatment, 23 patients filled in a questionnaire which included 20 multiple‐choice questions exploring four dimensions: psychological, physical and social functioning, and pain. Results: At the clinical control seven patients had no clinical symptoms related to the malformation, six had slight, four moderate, and two severe symptoms. In 16 patients the symptoms had diminished after treatment. No deterioration of the initial situation was observed. The results concerning quality of life showed that most patients did well after endovascular treatment. Pain was the most important injurious factor for state of health among the four different dimensions. The poorest outcome was found in malformations that filled the whole muscle or muscle compartment and in larger lesions. The patients whose malformation at the clinical control caused swelling to the extremity affected had poorer quality indices than others. Conclusion: Endovascular treatment for venous malformations is an effective treatment.

Acute supraglottitis in adults in Finland: Review and analysis of 308 cases

The aim of this article is to study the clinical features, management, and outcome in adult patients with acute supraglottitis.

Accuracy of the current TNM classification in predicting survival in patients with sinonasal mucosal melanoma

The first International Union Against Cancer (UICC) TNM classification for aerodigestive malignant mucosal melanoma was not published until 2009, and since then, only a few studies have evaluated the accuracy of this staging system. Our aim was to evaluate the accuracy of this UICC staging system for sinonasal malignant mucosal melanoma (SMMM) in a nationwide survey.

Temporal Relationship between Human Parechovirus 1 Infection and Otitis Media in Young Children

BACKGROUND Human parechovirus (HPeV) 1 is a common virus that infects almost everyone during childhood. Because clinical symptoms are poorly documented, we evaluated the symptoms associated with HPeV1 infection in a cohort of children followed prospectively from birth at 3-month intervals. METHODS Symptoms such as fever, cough, those of the common cold, otitis media, and gastroenteritis were determined from hospital records and from questionnaires administered to the parents of 59 children during regular study visits. HPeV1 infections were diagnosed by measuring neutralizing antibodies in follow-up serum samples. Additionally, HPeV RNA was analyzed in middle ear fluid (MEF) and nasopharyngeal aspirate samples from 33 patients with otitis media by reverse-transcription polymerase chain reaction. RESULTS Otitis media showed a clear association with HPeV1 infection-it developed in 50% of the 3-month follow-up periods that yielded evidence for HPeV1 infection but in only 14% of the HPeV1-negative periods (odds ratio [OR], 6.14 [95% confidence interval {CI}, 2.75-13.77]). In children with recurring otitis media, MEF samples were positive for HPeV in 15% of episodes. Cough was also associated with HPeV1 infection, but this association was weaker (OR, 3.67 [95% CI, 1.66-8.09]). Other symptoms were not linked to HPeV1 infection. CONCLUSIONS HPeV1 infections are common in childhood and may cause otitis media and cough.

Correlation between rhinometric measurement methods in healthy young adults.

The most common rhinometric measurement methods used in modern rhinology are acoustic rhinometry, rhinomanometry, and nasal peak expiratory flow (PEF) rate. In this prospective study, we wanted to clarify whether the parameters given by these three methods in the same subject support each other and can be used simultaneously in clinical practice. We also wanted to define the dimensions of normal nasal geometry and function based on these three methods. The rhinometric measurements were done in 249 healthy white subjects consisting of 171 women and 78 men. The geometry was analyzed with regard to body mass index (BMI) and smoking habits. The result could be used as some kind of reference value for the same kind of patient cohort as when rhinological pathology is investigated. The measurements obtained by acoustic rhinometry showed only statistically significant correlations between the measured volume and minimal cross-sectional area in the nasal cavities (r = 0.959). Rhinomanometry showed only a statistically significant correlation between the measured resistance in expiration and inspiration (r = 0.977). Acoustic rhinometry, rhinomanometry, and nasal PEF did not show any correlations and the BMI did not have any effect on the results. Although the smoking group was relatively small in this cohort, the rhinometric methods showed smaller nasal cavity volume, higher resistance, and lower nasal PEF values. Based on these results, we recommend the use of these three rhinometric methods as independent instruments in rhinological examinations. However, in the pathological nose, e.g., smokers, the methods show equal changes in measurements. It is important to measure at least acoustic rhinometry and rhinomanometry at the same time in clinical practice to achieve good quality of examinations.