Magnus G. Lind

HYPERBARIC OXYGEN THERAPY FOR WOUND COMPLICATIONS AFTER SURGERY IN THE IRRADIATED HEAD AND NECK: A REVIEW OF THE LITERATURE AND A REPORT OF 15 CONSECUTIVE PATIENTS

Radiotherapy, which is often used for cancer in the head and neck, leads to damage of tissue cells and vasculature. Surgery in such tissues has an increased complication rate, because wound healing requires angiogenesis and fibroplasia as well as white blood cell activity, all of which are jeopardized. Hyperbaric oxygen therapy (HBO) raises oxygen levels in hypoxic tissue, stimulates angiogenesis and fibroplasia, and has antibacterial effects.

Radiographic diagnosis of foreign bodies in the oesophagus

In a group of patients suspected of harbouring a foreign body in the oesophagus, the diagnostic accuracy of radiographic examination is found to be high. Only 1 of 243 patients examined by radiography presented a false negative result.

Irradiation of Rabbit Submandibular Glands Histology and Morphometry after 15 Gy

Irradiation of rabbit submandibular glands with a single absorbed dose of 15 Gy caused tissue damage which persisted 4 and 10 months later. The injuries were studied by histology, measurement of gland weights and histomorphometry. Reduction of gland weight due to hypoplasia and missed weight gain were seen and the proportions of the three major intralobular compartments of the glands were altered being dependent on the interval between radiation exposure and observation time. The size of the lobules was reduced and extralobular fibrosis in the hilar region increased. The seromucous acini were partly atrophied, with successively changed architecture and reduced size of the granules. The serous tubules showed pronounced reduction of the granules at 4 months and a remarkable adenomatous regeneration at 10 months post irradiation. The striated ducts were almost unaffected during the observation time. Arteriolar changes were slight to moderate, and there was scarcely any capillary damage. The numbers of intra- and extralobular plasma cells were increased.

Influence on Rabbit Submandibular Gland Injury by Stimulation or Inhibition of Gland Function during Irradiation: Histology and Morphometry after 15 Gray

The loss of salivary gland function after a single dose of 15 Gy was correlated to loss of gland weight and degeneration of seromucous acini and serous tubules at 10 months postirradiation. The serous tubules were degranulated rather early, but regenerated after some months in an abnormal way as adenomatous structures. Striated ducts were mainly unaffected by irradiation. Arterioles showed slight to moderate narrowing of the lumina. There was an increased amount of plasma cells in the gland lobules at 10 months postirradiation. Histologic and morphometric criteria and changes in gland weight showed less pronounced radiation injury in glands irradiated during inhibition of the gland function by biperiden (Akineton) compared to glands irradiated during stimulation of the gland function by pilocarpine. This finding may offer a clinically important means to reduce salivary gland dysfunction after radiation treatment of tumors in the head and neck regions.

A Swab Technique for Sialometry

A modification of the swab method for sialometry is described. The individual secretions from the right parotid gland, left parotid gland and both submandibular glands together were collected, by use of cotton swabs after submaximal stimulation by citric acid. Five evaluation parameters and their normal ranges and variances are described from a material of 150 control individuals without sign of salivary gland impairment. The measurement is performed within five minutes, it is simple and convenient both for the patient and the staff. Therefore the method described is well suited for routine clinical use.

Scintigraphy of Human Autologous Rib Transplants to a Partially Resected Mandible

The 99Tcm-DP accumulation in split ribs grafted to six cases of partially resected mandibles was examined by scintigraphy at different time intervals after operations and found to be higher than in normal facial bones. The accumulation was highest around one month after the grafting procedure, and later decreasing. Differences between bone chips, split ribs and unsplit ribs are described. Bone scintigraphy is assumed to be of value in following the metabolic state of bone grafts.

Temporal Bone Scintigraphy: I. Diagnostic Potential in Malignancies of the Ear

The potential value of bone scintigraphy in making the diagnosis and evaluating the prognosis of cancer of the ear, is emphasized and illustrated by results from 6 patients harbouring highly differentiated cancers of the ear. 99Tcm-diphosphonate and special gamma camera projections were used.

Radiosialometry: II. The Diagnostic Accuracy of Different Evaluation Parameters

The temporal course of 99TcmO4 accumulation in the parotid gland after fast intravenous injection of the radionuclide was measured quantitatively by radiosialometry in 32 patients suffering from inflammatory or neoplastic diseases of the parotid glands. The diagnostic accuracy of five different evaluation parameters was compared. It was found that without reducing diagnostic accuracy, the method used could be simplified by omitting three of the five evaluation parameters. This implies a shortening of the measuring time from 18 to 10 minutes. The diagnostic accuracy of radiosialometry in 14 cases with a general engagement of the parotid parenchyma (irradiation damage, collagen sialosis and chronic recurrent parotitis) was high. Thus, all these 14 cases had abnormal radiosialometric values. Parotid tumours not causing extensive destruction of the parotid parenchyma were not detected by this method.

Morphology and histochemistry of rabbit submandibular glands

The rabbit submandibular glands are of the heterocrine type. The most distal part of the ductal system consists of secretory endpieces, which are constructed mainly of two morphologically and histochemically different and distinct structures: distally the seromucous acini and proximally the serous tubuli. The cells of the seromucous acini are strongly AB pH 2.5 positive, AB pH 1.0 negative and PAS negative, indicating production of acid glycoproteins--mainly sialomucin. The cells of the serous tubuli are AB pH 2.5 negative and strongly PAS positive, indicating the presence of neutral glycoproteins. Glycol methacrylate embedded sections (Historesin) stained with a modified Trichrome stain were superior to standard paraffin sections regarding resolution and clarity of morphological details. Quantitative studies of intralobular structures on AB-PAS-stained paraffin sections compared with Trichrome-stained glycol methacrylate sections gave corresponding results. The latter method is well suited for study of structural changes in submandibular glands, as in assessing the effect of ionizing irradiation.

Radiosialometry: I. A Method for Evaluation of Salivary Gland Disorders

The temporal course of the total 99Tcm40 acumulation in the parotoid glad after fast intravenous injection of the readionucleotide, is studied by examination with quantitative radiosialometry. The method adopted is based on the use of two collimated, symmetrically located and opposite placed NaI-detectors. The normal ranges of five evaluation parameters are obtained from a control material of 100 parotoid glands in 50 individuals without disorders of the parotoid glands. The reproducibility of these five evaluation parameters is estimated and the sensitivity and the detectability of the parameters as well as different sources of variation are discussed. Classification boundaries between normal and abnormal valves values are arbitrarily chosen form the normal ranges.