Karin Petruson

Quality of life as predictor of weight loss in patients with head and neck cancer

The purpose of this prospective study was to evaluate whether a relationship exists between malnutrition (≥10% weight loss) and health‐related quality of life (HRQL) in patients with head and neck cancer and whether weight loss can be predicted with HRQL questionnaires.

Transient expression of insulin-like growth factor I immunoreactivity by vascular cells during angiogenesis.

The present study was undertaken to investigate whether vascular cells show insulin-like growth factor I (IGF-I; somatomedin C) immunoreactivity under normal conditions and/or during angiogenesis in humans and animals, as the trophic peptide IGF-I is considered important for cell growth and differentiation. In adult animals normal blood vessels, i.e., arteries, veins, and capillaries, did not show any IGF-I immunoreactivity. In newborn animals every vascular cell showed IGF-I immunoreactivity; the frequency and intensity thereafter decreased and eventually vanished as the animals approached maturity. Injury of a tissue or organ rapidly induced extensive blood vessel formation and such new blood vessels transiently expressed IGF-I immunoreactivity. Endothelial cells in budding capillaries showed distinct cytoplasmic IGF-I immunoreactivity, as did endothelial cells, smooth muscle cells, and fibroblast in newly formed arteries and veins. In biopsies of human tissue, transient IGF-I immunoreactivity was evident in vascular cells during angiogenesis after injury, as it also was in granulation tissue, skin wounds, and scar capsules around implants. Increased IGF-I immunoreactivity was further demonstrated in vascular cells in biopsies from patients with other changes involving blood vessel formation, e.g., nasal polyps, and in specimens from patients with arteritis, tendonitis, synovitis, Wegeners granulomatosis, idiopathic midline destructive disease, neurofibromatosis (von Recklinghausens disease), and muscular dystrophy. It is concluded that during angiogenesis, obviously irrespective of inducing factors and mechanisms, vascular wall cells transiently show IGF-I immunoreactivity.

Juvenile nasopharyngeal angiofibroma: long-term results in preoperative embolized and non-embolized patients.

A treatment and follow-up study of 32 patients with juvenile nasopharyngeal angiofibroma (JNA) was performed at our clinic between 1974 and 1998. The majority had undergone surgery either via an antral approach or with a lateral rhinotomy. In the 1970s, surgery was combined with ligature of the external carotid artery and, since 1981, it has been combined with preoperative embolization. Two patients received radiotherapy (45 Gy) as primary treatment and the 3 cases of multiple recurrence received radiotherapy (30-45 Gy) as secondary treatment. No recurrence was found in patients treated with radiotherapy. The overall recurrence rate was 25%; the recurrence rate in non-embolized patients was 8% and among embolized patients it was 41%. We found no statistically verified differences in recurrence rate between embolized and non-embolized patients. No statistically significant difference was found in either recurrence or peroperative bleeding when comparing preoperatively embolized patients with non-embolized patients. Regression analyses showed that the only factor affecting recurrence was age, i.e. the younger the patient was at diagnosis the greater the risk of developing recurrence. The development of imaging and embolization techniques will hopefully contribute in the future towards reducing the recurrence rate.

Effects of psychosocial intervention on quality of life in patients with head and neck cancer.

A longitudinal, prospective, case‐control study evaluated if a psychosocial support program improved health‐related quality of life (HRQL) in head and neck (H&N) cancer patients.

Insulin-like growth factor I is a possible pathogenic mechanism in nasal polyps.

High concentrations of the trophic peptide insulin-like growth factor I (IGF-I; somatomedin C; SmC) were demonstrated immunocytochemically in all nasal polyps examined, except in areas with necrosis or tissue defects. Most epithelial cells, activated macrophages, and proliferating blood vessels, proved positive, contrasting with the low degree of cellular staining in adjacent normal nasal mucosa. It is proposed that nasal mucosal inflammatory reactions induce local formation and accumulation of IGF-I, which may eventually result in very high IGF-I concentrations in the paranasal sinuses due to the tendency these have to be enclosed, i.e. producing reduced drainage. Assuming that IGF-I constitutes the pathogenic factor, appropriate treatment should be given to reduce the inflammatory reactions and improve drainage.

Results of preoperative chemoradiotherapy for patients with advanced cancer of the nasal cavity and paranasal sinuses

Abstract Objectives: Curative treatment of nasal cavity and paranasal sinus cancer is challenging due to the proximity to critical anatomical structures. The purpose of this study was to analyze the impact of trimodality therapy with preoperative chemotherapy and reduced-dose radiotherapy followed by organ-preserving surgery for treating patients with nasal cavity and paranasal sinus cancer. Methods: This retrospective study included all 156 patients diagnosed with sinonasal cancer in western Sweden between 1986 and 2009. We determined the treatment selection pattern and treatment outcomes for 79 patients treated with preoperative chemoradiotherapy. Results: Squamous cell carcinoma was the most common histology. The five-year overall survival was 54%, and 85% of these patients had T3 or T4 tumors. The five-year cumulative incidence rate of local recurrence was 32%. The five-year overall survival in patients with squamous cell carcinoma and adenocarcinoma was 45% and 76%, respectively. The median preoperative radiation dose was 48 Gy. Orbital exenteration was performed in 7% of patients. Conclusions: Preoperative chemoradiotherapy may be beneficial for patients with advanced sinonasal cancer when primary radical surgery is challenging. Survival outcomes were comparable to outcomes reported in the literature despite conservative surgery and relatively low radiation doses in patients with locally advanced tumors.

Nitric oxide production in the sphenoidal sinus

Abstract Problem: Nitric oxide (NO) is considered to prevent local infections in paranasal sinus. As sphenoidal sinusitis is rare our hypothesis was that NO concentration is higher in spenoidal sinus than in maxillary sinus. The sphenoidal sinus is not easily accessible and NO concentration in this sinus has been reported in one patient. We studied the presence of NO and NO-synthesizing enzymes (NOS), in the maxillary and sphenoidal sinus. Methods: Ten patients (3 male; mean age, 55 years) undergoing surgery for pituitary adenomas were examined perioperatively. Patients were orally intubated and gas samples were taken during the first hour of surgery. By using chemiluminiscence technique the presence of NO gas in the maxillary and sphenoidal sinus was measured. Distribution of different NOS and NADPH-diaphorase in mucosal biopsies was also studied. Results: The individual concentration of NO was approximately half in the sphenoidal sinus compared to the maxillary sinus. Mean value of NO in the sphenoidal sinus was 2575 ppb and in the maxillary sinus 6792 ppb. Morphological analyses revealed presence of the isozymes: inducible NOS, neuronal NOS, and endothelial NOS, as well as NADPH-diaphorase, in the mucosa of the maxillary and sphenoidal sinus. Most abundant was inducible NOS. Conclusion: In this small study we found lower concentrations of NO in the sphenoidal sinus than the maxillary sinus. Significance: The concentration of NO, and the abundant presence of inducible NOS in the sphenoidal sinus in these nonallergic, noninfected patients will be discussed. Support: None reported.