Staffan Edström

Malnutrition and food intake in relation to quality of life in head and neck cancer patients

The quality of life (QL) of cancer patients has attracted an increasing interest in recent years. Patients with head and neck cancer often have troublesome symptoms due to the disease and to treatment side effects, which will have an impact on the patients QL. The aim of this study was to evaluate the possibility of studying QL in relation to well‐known clinical parameters.

Percutaneous Sclerotherapy of Venous Malformations of the Head and Neck Using Sodium Tetradecyl Sulphate (Sotradecol)

Thirty-eight patients with venous malformations of the face, neck, and tongue underwent percutaneous sclerotherapy with direct puncture and instillation of sodium tetradecyl sulphate (Sotradecol) (33-67% solution, mixed with contrast material) into the lesions. Each patient underwent from one to seven treatment sessions (mean 2.2), followed by reconstructive surgery in three cases. Of the 34 patients who responded to the follow-up questionnaire, the late results were excellent or good in 23 patients (68%), moderate in eight, unchanged in three, and were worse in one. Compared with our previous experience of embolisation of such malformations with ethanol, the results with Sotradecol were slightly worse. There was one serious complication, unilateral loss of vision in a patient with a large malformation that extended to the orbit. In conclusion, percutaneous sclerotherapy with Sotradecol is effective treatment for venous malformations of the head and neck. Careful planning is essential to reduce the risks of the treatment.

The relationship between cervical cysts and tonsillar carcinoma in adults

An investigation of the clinical results in 42 patients with lateral cervical cysts is presented. Fine needle aspiration biopsy suggested malignancy in three cases. After surgical removal, another six cases of malignancy were revealed by histologic examination. In six of the nine cases of malignancy, an ipsilateral tonsillar carcinoma was found on routinely performed tonsillectomy. However, the clinical appearance of the tonsils was normal in four of these patients. Analysis of all patients according to age revealed that the malignancy rate was 80% among those aged greater than 40 years. It is suggested that tonsillectomy for histologic examination should be performed routinely when lateral cervical cysts are removed in adults.

HEARING IMPAIRMENT IN PATIENTS WITH ANTIBODY PRODUCTION AGAINST BORRELIA BURGDORFERI ANTIGEN

This study aimed to evaluate the extent to which hearing disorders may be a result of tick-borne Borrelia burgdorferi infection. 98 patients with different patterns of hearing dysfunction were studied. The patients had a history of sudden hearing loss, disorders similar to Menières disease, or hearing loss in combination with acute facial palsy or with vertigo. Serum antibodies against the B burgdorferi antigen were determined during the acute and convalescent periods. 17 patients (17%) showed serological evidence of borreliosis (reciprocal titre of 320 or above). All but 3 of these patients also had vertigo and 3 subjects had peripheral facial palsy. All the 17 patients were treated with high doses of intravenous benzylpenicillin. The hearing of 5 patients improved on treatment. Although the specificity of antibody production against borrelia antigen has not been completely clarified, it is concluded that repeated serological examinations are worthwhile in patients with unexplained hearing disorders.

Verrucous Squamous Cell Carcinoma of the Larynx: Evidence for Increased Metastatic Potential after Irradiation

Verrucous squamous cell carcinoma is a rare type of well-differentiated squamous cell carcinoma with a characteristic morphologic appearance and specific clinical behavior. It has been claimed that this tumor may undergo dedifferentiation after radiotherapy; this will result in a more aggressive behavior. From 1968 to 1980, we have diagnosed and treated 569 squamous cell carcinomas of the larynx. Fourteen of them were reported to exhibit verrucous features macroscopically. These tumors were histopathologically reexamined. All 569 cases were stratified with regard to tumor stage (≤T2 N0 M0) and treatment (irradiation). Six patients of 340 were then diagnosed as having verrucous squamous cell carcinomas, according to the Ackerman criteria. The patients were followed for at least 5 years and regional metastases of poorly differentiated carcinoma developed in at least two patients in the verrucous carcinoma group within 2 1/2 years after full-dose irradiation. Among the patients with nonverrucous carcinoma, this frequency was estimated to be 3%. This study provides evidence that metastatic spread that occurs after irradiation is approximately 10 times more frequent (p < 0.05) for T1–2 laryngeal verrucous carcinomas, as compared to the common type of squamous cell carcinoma.

Ménière's disease and antibody reactivity to herpes simplex virus type 1 polypeptides☆

PURPOSE It has been reported that the inner ear is capable of responding to antigen challenge. In this study, we have investigated the antibody reactivity to herpes simplex virus 1 (HSV-1) proteins in sera from patients with Ménières disease. PATIENTS AND MATERIALS Serum from 21 patients scheduled to undergo endolymphatic sac decompression for Ménières disease was obtained. The sera from 21 age- and sex-matched individuals without a history of ear disease served as the control. An enzyme-linked immunosorbent assay (ELISA) was used to detect antibodies to HSV-1, HSV-2 cytomegalovirus (CMV), varicella-zoster virus (VZV), and measles virus. Immunoblotting was used to confirm and further evaluate the HSV-1 antibody response. RESULTS All but one patient had antibodies to HSV-1. ELISA mean log titers were significantly lower in the patient group to CMV and VZV when compared with controls. A pattern of generally higher antibody reactivity in patients with Ménières disease was demonstrated to the individual SDS-PAGE HSV-1 polypeptides as judged by immunoblotting. CONCLUSION The HSV-1 antibody response found in patients with Ménières disease may indicate viral reactivation and denotes the importance of further studies on the role of infectious agents in this disease.

Multiple unrelated chromosome abnormalities in a metastatic mucoepidermoid carcinoma of the parotid gland

We describe cytogenetic findings in a poorly differentiated, metastatic mucoepidermoid carcinoma of the parotid gland. The tumor was characterized by multiple, unrelated chromosome abnormalities. Except for two small aberrant clones showing t(1;7) and t(2;15), respectively, all other abnormal cells showed unique, mostly structural rearrangements peculiar to each cell. No less than 34 different abnormal karyotypes were observed. A similar karyotypic heterogeneity was also described recently in squamous cell carcinomas of the head and neck.

Elevated Levels of Myelin Basic Protein in CSF in Relation to Auditory Brainstem Responses in Bell's Palsy

Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) was quantified from 28 patients with acute facial palsy. The mean value of MBP in CSF in the study group was 3.4±0.22 μg/1 (mean±SEM), which was significantly higher than the found in 37 healthy subjects (2.4±0.13 μg/1). Using a 95% confidence interval, 10 patients demonstrated significantly increased CSF concentrations of MBP (>3.95 μg/I). Auditory brainstem response (ABR) test showed that 5 patients had abnormal brainstem responses. No significant correlation was observed between elevated MBP in CSF and either pathologic auditory brainstem responses or the clinical degree of the palsy. These results suggest that a brainstem involvement may occur in patients with Bells palsy. Furthermore, our data accord with previous reports suggesting Bells palsy to be part of a polyneuropathy.

Auditory Brain Stem Response Abnormalities in Patients with Bell's Palsy

To evaluate the hypothesis of CNS involvement in Bells palsy, the auditory brain stem responses (ABR) of 31 patients were studied. In nine of these patients ABR abnormalities were found. None of these patients showed evidence of dysfunction of the cochlear nerve. Six of the patients who had abnormal ABR were retested after they recovered from the facial paresis. Five of these patients showed persistent ABR abnormality, and one showed a normalization of the ABR. These results may be consistent with an injury at the brain stem level in some patients with Bells palsy. The possible causative agent of a reactivation of a herpes simplex virus infection is discussed.

The lack of correlation between proliferation (Ki-67, PCNA, LI, Tpot), p53 expression and radiosensitivity for head and neck cancers

SummaryA study was made of the relationship between measurements of radiosensitivity versus proliferation and p53 status in head and neck cancers. Inherent tumour radiosensitivity was assessed as surviving fraction at 2 Gy (SF2) using a clonogenic soft agar assay (n = 77). The results were compared to data on proliferation obtained by both flow cytometry (labelling index (LI), the potential doubling time (Tpot) n = 55) and immunohistochemistry (Ki-67 and PCNA; n = 68), together with immunohistochemical p53 expression (n = 68). There were no overall significant differences in the median values of the various parameters analysed for the different sites within the head and neck region, disease stages, grades of tumour differentiation or nodal states. A subgroup analysis showed that oropharyngeal (n = 22) versus oral cavity (n = 35) tumours were more radiosensitive (P = 0.056) and had a higher Ki-67 index (P = 0.001). Node-positive tumours had higher LI (P = 0.021) and a trend towards lower Tpot (P = 0.067) values than node-negative ones. No correlations were seen between SF2 and any of the parameters studied. The long-standing dogma of an increased radiosensitivity of rapidly proliferating cells in contrast to slowly proliferating cells was not confirmed. The study shows that parallel measurements of different biological markers can be obtained for a large number of patients with head and neck cancers. The independence of the various parameters studied suggests that there may be potential for their combined use as prognostic factors for the outcome of radiotherapy.