Outpatient surgery of the first ray of the foot: post-operative pain monitoring at home

INTRODUCTION

At present, health facilities are forced to switch to outpatient care. While it lends itself well to this organizational arrangement, first ray surgery is broadly considered as painful by patients, who are often reluctant to this treatment. The evolution of post-operative pain in patients who underwent operations for first ray surgery from D0 to D15 were studied. Secondly, the duration of the oral analgesic treatment, the patient's satisfaction level, and searched for complications were assessed.

METHODS

This is an observational, single-center and single-operator study. Between July and December 2019, forty patients who underwent first ray surgery (hallux valgus or rigidus) and eligible for outpatient treatment were included. The surgical technique of the hallux valgus treatment consisted of open surgery via double metatarsal and phalangeal osteotomy. The hallux rigidus surgery consisted of arthrodesis using an open dorsal plate. Home monitoring was carried out by a healthcare provider (e-HORUS). The protocol provided for pain management by means of a diffuser of Nefopam IV for a maximum of 5 days, combined with alleviating oral analgesics 1 and 2 and NSAIDs. The pain was evaluated on D0, D1, D3, D5, D8 and D15, using a numerical scale (NS) from 0 to 10. The degree of patient satisfaction was recorded at 1 month.

RESULTS

35 patients were followed. 5 patients were excluded due to incomplete data. The series included 26 women and 9 men, with an average age of 59.9 years. There were 30 hallux valgus and 5 hallux rigidus. The pain analyzed by the NS was 5.37 on D0, 3.34 on D1, 1.83 on D3, 1.43 on D5, 1.06 on D8 and 2.2 on D15. The average duration of Nefopam infusions was 3.89 days, and the average duration of oral analgesics was 17.7 days. The tolerance of the treatment was satisfactory in 79% of the cases. 69% of patients were very satisfied with the management of their pain. There were no scar complications or infections. No re-hospitalization was necessary. 3 algoneurodystrophies were identified. The existence of fibromyalgia or Parkinsonian syndrome was correlated with higher pain.

DISCUSSION-CONCLUSION

Pain management after outpatient first ray surgery using the injectable Nefopam protocol was satisfactory in the majority of cases, with a high degree of patient satisfaction. This protocol is routinely offered to our patients who must undergo first ray surgery.

Flow cytometric DNA ploidy and recurrence development in squamous cell carcinoma of the oral cavity

This prospective study on 348 patients with oral squamous cell carcinoma who underwent radical surgery established a close association between the DNA ploidy status of the primary tumor and the risk of local recurrence development. Nine percent of patients with flow cytometrically diploid tumors developed a recurrence compared to 46% of those with aneuploid tumors. This correlation held true even if evaluated with respect to tumor stage or histological grade. Thirteen percent of the diploid and 59% of the aneuploid group showed lymph node metastasis. These results provide substantial evidence that cytogenetic events that underlie aneuploidy formation from initially diploid progenitor cells are functionally linked to the development of tumor cell populations that have the capability to establish independently growing colonies in foreign tissues.

Cytogenetic progression and prognosis in oral-carcinoma - a DNA flow cytometric study on 317 cases

A total number of 317 consecutive patients with squamous cell carcinoma of the oral cavity were analysed by DNA flow cytometry. The proportion of tumors consisting exclusively of diploid cells decreased from 75% in T1G1 carcinomas to less than 10% in advanced tumors in favor of cases characterized by the presence of cell lines with aberrant DNA content. This observation indicates a genetic evolution of tumor clones with severe karyotype aberrations from diploid progenitors which obviously represents an ultimate event in the pathogenesis of oral carcinomas. Aneuploidy formation clearly contributes to the acquisition of progressive malignant behaviour as is underlined by a dramatic difference of the survival outcome of patients with diploid tumors (5-year overall survival: 88%) as compared to those who had aneuploid tumors (36%; P<0.001), a relationship which held true even if identical tumor stages were considered. There were no indications of successive genetic changes of the cellular DNA contents during tumor progression which would explain the wide range of variation of the individual DNA values. This observation supports the hypothesis of an aneuploidy formation by a single cytogenetic event, such as an abnormal mitosis. Although there were indications of an even worse survival outcome in the group of patients with peri-diploid tumor cell lines (P<0.1), a significant influence of different DNA contents on the prognosis could not be detected.

Flow cytometric S-phase fraction contributes to diagnosis of diploid malignant salivary gland tumours

DNA ploidy studies on salivary gland tumours have shown that the proportion of aneuploid cases, although confined to the malignant entities, is considerably lower than for other solid malignancies. To analyse whether the S-phase fraction (SPF) may contribute to discrimination of diploid malignant from benign tumours, DNA flow cytometric data from 45 different malignant salivary gland tumours was compared with that of 121 pleomorphic adenomas. All benign tumours were diploid. Twelve malignant tumours contained aneuploid cell populations. The SPF values for diploid malignancies ranged between 0.9% and 11.0% (mean 3.9%), and between 0.5% and 7.9% (mean 2.7%) for pleomorphic adenomas. A 4% cut-off value gained statistical significance for discriminating diploid malignant tumours from pleomorphic adenomas (P<0.01). The sensitivity for SPF>4% was 46% and the positive predictive value was 40%. A sensitivity of 60% and a positive predictive value of 54% was achieved by combining aneuploidy and SPF>4%. These results show that DNA flow cytometry may contribute to diagnostic assessment in salivary gland tumours.

Fibromyalgia and Gaucher's disease

BACKGROUND

Patients with symptomatic Gaucher's disease sometimes have non-specific symptoms (such as general malaise with widespread musculoskeletal pains) that respond poorly to enzyme replacement treatment. These may indicate fibromyalgia syndrome; if so, other therapeutic options might be more appropriate.

AIM

To identify patients with Gaucher's disease for whom fibromyalgia-specific therapy may be therapeutic.

DESIGN

Questionnaire-based survey.

METHODS

Adult patients (n = 109) with non-neuronopathic Gaucher's disease and adult healthy controls (n = 108) completed health-related questionnaires including the Fibromyalgia Impact Questionnaire, and underwent testing with a dolorimeter to ascertain sensitivity at 22 tender points.

RESULTS

Six patients, but no controls, met the criteria for fibromyalgia. Patients with fibromyalgia had a significantly greater incidence of co-morbidities (p = 0.014) relative to other patients with Gaucher's disease; four suffered from bone involvement and were receiving enzyme therapy, but two were untreated.

DISCUSSION

The presence of fibromyalgia-specific trigger points may result from multiple aetiologies, or may be an independently-sorting predisposition. Our findings cannot distinguish between these possibilities, but if fibromyalgia were the cause, enzyme replacement therapy would be expensive and inappropriate.

Gray ramus communicans nerve block: novel treatment approach for painful osteoporotic vertebral compression fracture

BACKGROUND

Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis in the aging population. Refractory chronic pain may develop, and few effective treatment options exist.

METHODS

We retrospectively analyzed 52 cases in which gray ramus communicans nerve block was used for painful OVCF after failure of conservative analgesic therapy. All were office-based, fluoroscopically guided procedures; a combination of 2% lidocaine and 2% sterile triamcinolone diacetate (Aristocort) was injected on the gray ramus tract of the somatic nerve root corresponding with radiographically documented OVCF. Patient-reported and physician-reported pain scores, analgesic medication use, and overall patient satisfaction were measured. The average follow-up period was 9 months.

RESULTS

A 1-point improvement in pain scores was reported by 92% of patients and 88% of physicians; a 4-point improvement was reported by 63% and 58%, respectively. No patients reported increased pain scores; physicians reported increases in two cases. Decreased analgesic requirement was documented in 42%. Patient satisfaction was "high" in 50% and "medium" in 25%. No procedural complications occurred.

CONCLUSION

Prompt and sustained improvements in all parameters, especially pain scores, support widespread clinical application of this safe effective and cost-effective therapy.

Stability of aneuploid clones during oral squamous cell carcinoma metastasis

BACKGROUND

The development of aneuploid clones contributes to the expression of metastatic growth properties in head and neck squamous cell carcinomas. Controversy persists as to whether aneuploid clones acquire an autonomous metastatic potential or instead activate diploid tumor cells to disseminate.

PATIENTS AND METHODS

DNA flow cytometry was performed on 73 primary oral squamous cell carcinomas and their synchronous lymph node metastases as well as on 20 other patients who experienced delayed manifestation of occult lymph node involvement.

RESULTS

Diploidy for both the primary and metastatic tumor was recognized in 6.5% of patients; 5.4% showed a shift from diploidy to aneuploidy while 3.2% had aneuploid tumors that associated with diploid metastases. Aneuploid clones in corresponding lesions were identified in 84.9% of cases. Despite the wide variation of individual DNA contents, 86.1% of the latter group expressed aneuploid clones with identical DNA indices in both the primary and metastatic tumors. The stability of initially established aneuploid clones was monitored even after 58 months of occult metastasis growth.

CONCLUSION

Lymph node metastases preferentially originate from pre-existing aneuploid tumor clones.

Prognostic value of graph theory-based tissue architecture analysis in carcinomas of the tongue

Several studies on oral squamous cell carcinomas (OSCC) suggest that the clinical value of traditional histologic grading is limited both by poor reproducibility and by low prognostic impact. However, the prognostic potential of a strictly quantitative and highly reproducible assessment of the tissue architecture in OSCC has not been evaluated. Using image analysis, in 193 cases of T1-2 (Stage I-II) OSCC we retrospectively investigated the prognostic impact of two graph theory-derived structural features: the average Delaunay Edge Length (DEL_av) and the average homogeneity of the Ulam Tree (ELH_av). Both structural features were derived from subgraphs of the Voronoi Diagram. The geometric centers of the cell nuclei were computed, generating a two-dimensional swarm of point-like seeds from which graphs could be constructed. The impact on survival of the computed values of ELH_av and DEL_av was estimated by the method of Kaplan and Meier, with relapse-free survival and overall survival as end-points. The prognostic values of DEL_av and ELH_av as computed for the invasive front, the superficial part of the carcinoma, the total carcinoma, and the normal-appearing oral mucosa were compared. For DEL_av, significant prognostic information was found in the invasive front (p < 0.001). No significant prognostic information was found in superficial part of the carcinoma (p = 0.34), in the carcinoma as a whole (p = 0.35), or in the normal-appearing mucosa (p = 0.27). For ELH_av, significant prognostic information was found in the invasive front (p = 0.01) and, surprisingly, in putatively normal mucosa (p = 0.03). No significant prognostic information was found in superficial parts of the carcinoma (p = 0.34) or in the total carcinoma (p = 0.11). In conclusion, strictly quantitative assessment of tissue architecture in the invasive front of OSCC yields highly prognostic information.

Multiparameter flow cytometry for simultaneous assessment of p53 protein expression and cellular DNA content in oral squamous cell carcinomas: evidence for the development of aneuploid clones from p53-deficient diploid progenitor cells

Diploid tumour cells regularly continue to progress after the development of aneuploid cell populations in head and neck squamous cell carcinomas. The coexistence of aneuploid clones with their diploid progenitor cells provides a unique opportunity to study the order of appearance of p53 mutation and aneuploidy in the same tumour. Multiparameter flow cytometry was therefore applied to 22 oral squamous cell carcinomas to simultaneously assess cellular DNA content and p53 protein expression on a single-cell basis. Concurrent measurements of cytokeratin expression served to identify tumour cells of epithelial origin. One of 5 diploid and 2 of 17 aneuploid carcinomas were p53-negative. For 15 p53-positive aneuploid tumours, overexpression of p53 protein was identified for the aneuploid clones as well as for coexisting diploid tumour cell populations in 14 cases. On the understanding that coexisting diploid and aneuploid tumour cell populations have a common clonal origin, these results provide evidence that aneuploid tumour clones typically develop from p53-deficient diploid progenitor cells. Loss of wild-type p53 function may therefore contribute to the development of aneuploidy in head and neck cancer.

High-resolution DNA flow cytometry in oral verrucous carcinoma

The classification of verrucous carcinoma as an entity unto itself or as a variant of well differentiated squamous cell carcinoma is controversial. To contribute new insights into the biological behavior of this rare tumor, we applied DNA flow cytometry to three node-negative verrucous carcinomas of the oral cavity. All tumors expressed a single aneuploid cell population. One of the patients experienced three courses with local recurrence. All secondary tumors retained the initially established aneuploid clone. The development of aneuploidy is thus a cytogenetic event common to both verrucous and squamous carcinoma of the oral cavity.

Chromosomal composition of aneuploid clones with different DNA contents in head and neck squamous cell carcinomas as determined by combined flow cytometry and fluorescence in situ hybridization

Studies with DNA flow cytometry (FCM) have shown that DNA contents of aneuploid tumour clones vary in a wide range. The aim of this study was to analyse whether homologous chromosomal changes exist despite the individual differences that may be of general relevance for the development of gross aneuploidy in squamous cell carcinomas of the head and neck. Fluorescence in situ hybridization (FISH) with 13 centromere-specific DNA probes was applied to 3 diploid and 11 aneuploid tumours with DNA indices ranging between 0.8 and 2.2. Disomic and monosomic cell populations were prevalent findings in DNA-diploid tumours. Polysomies were common in aneuploid tumours. Different degrees of aneusomy for identical chromosomes were recurrent features in aneuploid tumours. FISH signal heterogeneity was identified for all chromosomes. The mean number of aneusomic cell populations identified for DNA-aneuploid tumours ranged between 1.6 for chromosome 17 and 3.1 for chromosome 3. Inconsistencies between FISH and FCM data may indicate that centromere-specific DNA probes identify gains and losses of marker DNA due to complex karyotypic rearrangements rather than absolute changes in chromosome numbers. Overall, there was no evidence of the critical involvement of particular chromosomes in the development of different DNA contents.

Progression of diploid tumor cells in aneuploid head and neck squamous cell carcinomas

The development of aneuploid clones from diploid progenitor cells is a regular characteristic of head and neck squamous cell carcinoma progression. While the significance of aneuploidy formation for the acquisition of invasive and metastatic behavior is well documented, little is known about the contribution of diploid tumor cells after aneuploid clones have emerged. To distinguish diploid cells of epithelial origin from benign cellular components, we applied multiparameter flow cytometry of DNA content and cytokeratin (CK) expression to 36 primary tumors. Twenty-seven carcinomas accommodated aneuploid cell lines that stained positive for CK. All diploid cell populations obtained from aneuploid carcinomas contained CK-positive subpopulations as did all of nine tumors that consisted exclusively of diploid cells. The proportions of CK-positive diploid cells ranged between 6% and 80%, independent of whether they were achieved from entirely diploid or from aneuploid carcinomas. CK-gated diploid and aneuploid cell populations showed largely identical S-phase fractions. These results emphasize that diploid tumor cells regularly persist after the development of aneuploid clones and significantly contribute to local tumor progression. Despite the presence of diploid epithelial cells in aneuploid primary tumors, exclusively the aneuploid clones of eight corresponding lymph node metastases were CK-positive. This provides further evidence of a largely reduced metastatic potential of diploid tumor cells.

Warthin's tumour is not an Epstein-Barr virus related disease

BACKGROUND

The histogenesis of Warthin's tumour (WT) is controversial. A possible role for Epstein-Barr virus (EBV) has been suggested.

MATERIALS AND METHODS

Twenty formaldehyde-fixed, paraffin-embedded blocks of WT from the parotid gland were examined for the presence of EBV. In situ hybridisation was performed using EBV encoded small nuclear RNAs (EBER1/2) probes labelled with fluorescein isothiocyanate. An EBV-positive P3HR-1 cell line processed to paraffin wax was used as a positive control and a brain section as negative control.

RESULTS

EBER1/2 could not be found in the neoplastic epithelial cells in any of the tumours nor in the adjacent normal parotid tissues. Individual positive lymphocytes were present in 7 tumours.

CONCLUSIONS

These results indicated that EBV is not involved in the pathogenesis of WT.

DNA aneuploidy by flow cytometry is an independent prognostic factor in squamous cell carcinoma of the oral cavity

BACKGROUND

The clinical significance of flow cytometric DNA content in head and neck squamous cell carcinoma is still controversial.

PATIENTS AND METHODS

We prospectively investigated the prognostic importance of tumor size (T), lymph node involvement at presentation (N), degree of histologic differentiation (G) and DNA ploidy (DNA) in 429 surgically treated patients with primary oral squamous cell carcinoma using multivariate statistics.

RESULTS

T, G and DNA were independent predictors of metastasis to the neck. N and DNA were independent prognostic factors of loco-regional recurrence development. N and T were prognostic of overall survival. N and DNA were predictive of recurrence-free survival. For the neck negative group, DNA remained as the only predictor of overall and relapse-free survival.

CONCLUSION

DNA flow cytometry adds significant prognostic information beyond that provided by established prognostic factors.

The significance of DNA flow cytometry in predicting survival and delayed clinical manifestation of occult lymph node metastasis to the untreated neck in patients with oral squamous cell carcinoma

A total number of 116 clinically neck-negative patients with squamous cell carcinoma of the oral cavity who underwent radical primary tumour surgery without simultaneous neck treatment were entered into this prospective study. The 5 year overall survival rate was 87% for patients with flow cytometrically diploid tumours and 58% for the aneuploid group (P < 0.05). By multivariate survival analysis, tumour stage (P < 0.05) and DNA ploidy (P < 0.05) were significantly associated with the outcome. The cumulative 3 year rate of delayed clinical manifestation of lymph node metastasis to the previously untreated neck was 12.6% for patients with flow cytometrically diploid tumours and 41.3% for the aneuploid group (P < 0.01). By multivariate analysis, the DNA ploidy status of the primary tumour was the only factor among tumour stage, localization and degree of histological differentiation predictive of occult metastasis development (P < 0.05). Also, patients with T1 tumours who frequently are not considered to benefit from elective neck dissection were at high risk of subclinical lymph node involvement if the primary tumours were aneuploid (47%), whereas only 10% of the diploid T1 sample showed occult neck disease. Particularly in patients with less extensive oral carcinomas, DNA aneuploidy is therefore an important decisive factor in elective neck dissection.

High-resolution DNA flow cytometry in papillary cystadenoma lymphomatosum (Warthin's tumour)

Twenty-eight examples of papillary cystadenoma lymphomatosum (Warthin's tumour) of the parotid gland were analysed by high-resolution DNA flow cytometry. The mean coefficient of variation was found to be 1.19% (SD: 0.41). All tumours were DNA diploid. These results did not correspond with expected deviations based on published chromosomal studies. Also, the homogeneously low S-phase fractions (mean: 4.8%; SD: 2.7) found did not support the hypothesis of etiologically distinctive subgroups in these tumours.

Representativity of incisional biopsies for the assessment of flow cytometric DNA content in head and neck squamous cell carcinoma

DNA flow cytometry studies of squamous cell carcinoma of the head and neck have shown that patients with diploid tumours have favourable prognoses, whereas the outcomes of those with DNA aneuploid tumours are poor. DNA flow cytometry is therefore increasingly used as an integral part of diagnostic procedures. To evaluate how representative biopsies predict the DNA ploidy of oral carcinomas, incisional biopsies taken pretherapeutically from 256 tumours were compared with the corresponding surgical resection specimens. Sixty-six tumours exclusively displayed cells with flow cytometrically diploid DNA content in both the biopsy and the subsequent resection specimen, while 182 carcinomas expressed DNA aneuploid tumour cell lines in matched samples. There were only 8 tumours (3.1%) with heterogeneity in the DNA ploidy status between the biopsy and the resection specimen. These results emphasise the usefulness of incisional biopsies to reliably prognosticate the DNA ploidy status of oral carcinomas.

Correlation between p53 gene mutation, p53 protein labeling and PCNA expression in oral squamous cell carcinomas

BACKGROUND

The prevalence of oral squamous cell carcinoma (OSCC) among the Black community in South Africa is unacceptably high. The association between p53 protein, and PCNA overexpression and the presence of p53 gene mutations was evaluated.

MATERIALS AND METHODS

One hundred and ten formalin-fixed, paraffin-embedded blocks of OSCC were selected for immunohistochemical studies for p53 protein and PCNA expression using the DO-7 and PC10 monoclonal antibodies, respectively. DNA was extracted from fifty-five blocks and exons 5 to 9 of the p53 gene were amplified with nested primers, thereafter sequencing was performed to confirm the presence of mutations detected by single stranded conformational polymorphism.

RESULTS

Fifty-six cases (51%) showed p53 expression, while fourteen mutations (25%) were detected. A significant difference was found between the PCNA index in p53 positive and p53 negative tumors while the mean PCNA index for the tumors with p53 mutations was not significantly different from the tumors without mutations.

CONCLUSIONS

No association between p53 protein overexpression and p53 gene mutations could be demonstrated.

Comparison of DNA flow cytometry and fluorescence in situ hybridization with a set of 10 chromosome-specific DNA probes in four head and neck carcinomas

Four squamous cell carcinomas of the oral cavity were simultaneously analysed by DNA flow cytometry (FCM) and fluorescence in situ hybridization (FISH) with alpha-telomeric DNA probes specific for chromosomes 1, 2, 3, 6, 7, 8, 10, 12, 17, and X. Nuclei with 2 hybridization signals for most chromosomes were in agreement with flow cytometric DNA content in a diploid tumor, but a monosomy 8 for half of the cells indicated a tumor clone with an aberrant chromosome 8. Aberrations of virtually all chromosomes were found in 3 aneuploid tumors. Comparing the relative numbers of disomal and aneusomal nuclei with the corresponding proportions of DNA diploid and aneuploid sample cells provided evidence that the flow cytometrically diploid cell population of an aneuploid tumor consisted of both karyotypically normal and abnormal cells. Although there was a high degree of concordance between aberrant DNA content and magnitude of chromosomal aberration, discrepancies between both methods suggested a notable clonal heterogeneity in aneuploid tumor cell populations. These results demonstrate that a simultaneous application of DNA flow cytometry contributes to broaden the utility of interphase cytogenetics.

The value of DNA flow cytometry in predicting the development of lymph node metastasis and survival in patients with locally recurrent oral squamous cell carcinoma

BACKGROUND

DNA flow cytometry studies of squamous cell carcinoma of the head and neck have shown that patients with diploid tumors have favorable prognoses, whereas the outcomes of those with, aneuploid tumors are poor. This study was conducted to examine the importance of DNA ploidy in patients with locally recurrent oral carcinoma.

METHODS

DNA flow cytometry was performed on 93 primary oral carcinomas and their subsequent recurrences.

RESULTS

Eight patients with diploidy of both the primary tumor and the recurrence never developed lymph node metastasis. The 5-year overall survival rate of this group was 87%. For 80 aneuploid primary carcinomas, recurrences developed that were also aneuploid. Only 31% of these patients were 5-year survivors (P < 0.001). Lymph node metastasis at presentation was found in 55% of this group, whereas 13% of initially lymph node negative patients presented with regional disease at second surgery. Five of 13 diploid primary tumors recurred with aneuploid cell lines. Three of these five patients died, two with regional metastasis. The 5-year survival rate of patients with aneuploid recurrences who were never afflicted with lymph node involvement (41%) was better (P < 0.05) than the 5-year survival rate of those with metastasis at presentation or at second surgery (26%).

CONCLUSIONS

The excellent prognosis of patients with diploid primary tumors can be reestablished by treating local recurrences with radical surgery, if the surgery is performed before aneuploid cell lines have emerged. It appears that aneuploid tumor cell lines acquire unique properties that make them capable of invasion and metastasis.

Impact of tumor cell kinetics on the outcome of induction chemotherapy in oral carcinoma patients

Pretherapeutic S-phase fractions of 68 carcinomas of the tongue and the floor of mouth were analysed by DNA flow cytometry immediately before intra-arterial induction chemotherapy with cisplatin and epirubicin or 5-fluorouracil. Patients with diploid tumors had an excellent 5-year survival rate of 89% in contrast to only 31% in the aneuploid group. Cell proliferation had no impact on the outcome of diploid cases. Node-positive patients with aneuploid tumors had a poor 18% 5-year survival rate, independent of S-phase fractions. Survival was significantly worse in nodenegative patients with high proliferating aneuploid tumors (45%) compared to the low-proliferative N-0 group (83%).

Flow cytometric cellular DNA content and lymph-node metastasis in squamous-cell carcinoma of the oral cavity

This prospective DNA flow cytometric study on 386 primary squamous cell carcinomas of the oral cavity showed that only 18% of the patients with diploid primary tumors had lymph node metastasis on admission compared to 52% of those with aneuploid carcinomas. The aneuploid group without evidence of lymph node involvement at the time of primary tumor treatment carried a 3-fold increased risk for developing late metastasis (23%) compared with the diploid group (8%). The clinical manifestation of occult metastasis in patients with diploid carcinomas was delayed by about two years compared to the aneuploid group. These ploidy-specific differences of the metastatic behaviour held true even if stratified with respect to tumor stage, histological grade and tumor localization. These results provide substantial evidence that cells with gross DNA content aberrations have a significantly higher probability of successfully producing a metastatic colony than flow cytometrically diploid tumor cells. An excellent 5-year survival rate of 90% in the diploid NO group in contrast to 52% in aneuploid NO cases and an even worse survival rate of 21% in patients with lymph node involvement at presentation underline the clinical importance of these findings.

Anticancer drug action assessed by serial DNA flow cytometry during induction chemotherapy in oral squamous cell carcinoma: impacts on the development of individualized treatment strategies

Biopsy specimens from 53 advanced oral squamous cell carcinomas were taken before and after intra-arterial induction chemotherapy and analyzed by DNA flow cytometry. The 5-year overall survival rate was 90% in patients with diploid carcinomas in contrast to only 18% of those with pretherapeutically aneuploid tumors. A clear decrease of aneuploid cell numbers during chemotherapy indicated that DNA flow cytometry substantially allows monitoring of cytotoxic effects in vivo. Even if the immediate response to chemotherapy was significantly better in carcinomas with a complete disappearance of aneuploid tumor cells during treatment than in cases with persisting aberrant cells, the overall survival rate was nearly identical in both groups.

Monitoring of anticancer drug effects in vivo by serial DNA flow cytometry of oral carcinomas treated by intra-arterial 5-fluorouracil/cisplatin induction chemotherapy

Thirty-one patients with squamous cell carcinomas of the oral cavity who underwent intra-arterial induction chemotherapy with 5-fluorouracil and cisplatin were analysed by DNA flow cytometry. Seven tumors consisted exclusively of diploid cells and 24 were characterized by the presence of an aneuploid tumor cell line. Response to chemotherapy as well as survival were significantly better in the diploid group. The cytotoxic effect of the treatment on aneuploid tumor cell populations was monitored in vivo by serial DNA flow cytometric measurements. Decreasing numbers of aneuploid cells were detected in all but two cases (92%); twelve (50%) showed a complete disappearance of the aberrant cell line at the end of chemotherapy. All non-responders showed persisting aneuploid tumor cells at the end of treatment. Even if response to chemotherapy was better in the group with a complete disappearance of the aneuploid cell line in the course of treatment, the survival outcome of these patients did not differ significantly from those who showed persistence of aneuploid tumor cells.

Evidence for a pathway independent from 2'-deoxyguanosine and reversible by IL-2 by which purine nucleoside phosphorylase inhibitors block T-cell proliferation

Patients with homozygous deficiency of purine nucleoside phosphorylase (PNP) present with a T-cell selective immune deficiency. To elucidate the potential use of PNP inhibitors in the therapy of cutaneous T-cell lymphomas (CTCLs) the authors studied the effects of CI-1000 (formerly PD141955-2) and CI-972 on a T-cell line MyLa established from a patient with mycosis fungoides. Both PNP inhibitors had significant, dose-dependent, inhibitory effects on the proliferation of the T-cell line. CI-1000 (ED50: 3.7 microM) was approximately six-fold more potent in blocking 3H-thymidine uptake than CI-972 (ED50: 22.5 microM). The inhibitory effect of either substance could not be increased by addition of deoxyguanosine. Flow cytometric analysis revealed that both PNP inhibitors caused a block in the S-phase of the cell cycle. The inhibitory effect on proliferation was reversible partially by addition of IL-2. When testing proliferation inhibition of both substances on an IL-2-dependent T-cell line (SeAx), their inhibitory effects were reduced significantly. These data document a mechanism of action of the PNP inhibitors independent of deoxyguanosine and partially reversible by IL-2. The authors' observations suggest the potential use of PNP inhibitors in the therapy of cutaneous T-cell lymphomas and provide evidence for a pathway independent from deoxyguanosine by which PNP inhibitors might function in T cells.

The behaviour of neurogenic tumours of the maxillofacial region

In 37 patients with neurogenic tumours of the maxillofacial region, epidemiology, clinical, sonographical and computer tomographical findings as well as the results of fine needle aspiration cytology (FNAC), histopathological evaluation of biopsies and flow cytometric determination of DNA ploidy, were analyzed in order to detect characteristics distinguishing the behaviour of the neoplasm prior to resection. Simultaneous histopathological and flow cytometric evaluation of biopsies is recommended to avoid the danger of mistaking ancient schwannomas for malignancies and vice versa. FNAC proved to be unreliable in these cases. The retromaxillary/pterygomandibular region appeared to be the most likely site for malignant schwannoma. Von Recklinghausen's neurofibromatosis in the patient or in their family should lead to immediate investigation of any mass developing in the vicinity of the facial or trigeminal nerves.

[The Nikolowski trichoadenoma: a rare tumor of the ENT area]

A case of trichoadenoma Nikolowski in a 74-year-old woman is reported. The tumour invaded the upper lip, the base of the columella and the left nasal entrance. The tumour was cured by surgery and plastic reconstruction of the defect. This benign lesion of the hair follicles is rare and therefore often misdiagnosed as basal cell carcinoma or seborrheic keratosis. Examination of tumour cells by DNA-flow cytophotometry showed a normal diploid DNA-content of the tumour cells.

Comparison of flow cytometric DNA content in the primary tumor and in the corresponding lymph-node metastasis of patients with squamous cells carcinomas of the head and neck

The clonal DNA content of the cell populations of primary tumors and corresponding lymph node metastases was analysed by DNA flow cytometry in 48 patients with squamous cell carcinoma of the oral cavity. Three primary tumors were diploid, two associated with diploid metastases, one showing an aneuploid cell line in the secondary lesion. Fourty-five cases were aneuploid in both the primary tumors and in the synchronous metastases, all characterized by nearly identical DNA indices of the corresponding primary and secondary lesions. With few exceptions, aneuploidy formation appears to take place prior to dissemination of metastatic cells.

Dose dependence of the cytokinetic and cytotoxic effects of epirubicin in vitro

CHO cells were exposed in vitro for 1 h to concentrations of 0.1-20 micrograms/ml of the cytostatic drug epirubicin. Population growth, survival fractions, cell-cycle-phase distribution, and BrdU incorporation were analyzed. A fraction of the cells showed a transitory cytostatic reaction at 1 microgram/ml, and greater than 99% of the cells were killed at 10 micrograms/ml. The survival curve was biphasic with a steep slope at concentrations of up to 5 micrograms/ml. Approximately 0.1% of the cells were resistant to higher concentrations of epirubicin. Bivariate DNA/BrdU flow cytometry revealed that the sensitive cells were blocked and probably killed in the G2M phase of the cell cycle.

Monitoring of intra-arterial treatment with epirubicin and cisplatin in oral carcinoma by DNA flow cytometry

Twenty-two patients with squamous cell carcinoma of the oral cavity were treated intra-arterially with epirubicin and cisplatin. Biopsies were taken before, during, and after treatment and analysed by DNA flow cytometry. Clinical response to therapy was better in the diploid group as well as in previously aneuploid tumors which showed complete disappearance of the abnormal clone in the course of treatment. Poor reduction of tumor volume corresponded with persistence of aneuploid cells.

Flow cytometric DNA ploidy analysis of squamous cell carcinoma of the oral cavity. Comparison with clinical staging and histologic grading

The clonal DNA content of tumor biopsy specimens of 110 patients with primary and untreated squamous cell carcinoma of the oral cavity was determined by flow cytometric study. The ploidy status was compared with tumor size and histologic grading. Thirty tumors (27.3%) were diploid; in 80 cases (72.7%) cell lines with abnormal DNA content were detected. The portion of aneuploid tumors increased with decreasing degree of histologic differentiation (P less than 0.001) from G1 (38.1%) to G2 (76.6%) and G3 (92.0%). Only one of 13 T1 carcinomas (7.6%) showed abnormal clonal DNA content, but 76.9% of T2 and 90.6% T3 tumors (P less than 0.001) did. The emergence of aneuploid clones obviously represents a marker of malignancy progression in oral carcinoma.

Cytokinetic investigation of lung tumors using the anti-bromodeoxyuridine (BUdR) monoclonal antibody method: comparison with DNA flow cytometric data

In order to investigate the cytokinetics of malignant tumors and non-malignant lesions of the lung, tissue samples from 57 patients affected by non-small-cell carcinoma (NSCLC), small-cell carcinoma (SCLC), and benign and inflammatory lesions have been analyzed using the BUdR monoclonal antibody (MAb) method. This method is based on the preparation, at the time of surgery, of viable monocellular suspensions (using collagenase and DNase treatment) and the concomitant administration of BudR. The percentage of BudR-labelled cells was monitored by fluorescent microscopy using an FITC-labelled second antibody. In NSCLC, each histological group showed a wide range of labelling index (LI) values. On the contrary, SCLC exhibited a more homogeneous kinetic behaviour as evidenced by a narrowly distributed, higher LI. Tumors shown to be diploid by flow cytometry did not show a lower LI than aneuploid tumors. Furthermore, differences were constantly observed between the S-phase percent calculated using BUdR and that calculated using the DNA flow cytometric (FC) histogram, the latter always showing higher S-phase values. In an attempt to study the intra-tumor proliferative heterogeneity, multiple-site sampling was performed. Proliferative heterogeneity seemed to be higher inter-tumor than intra-tumor. Finally, a positive correlation (p less than 0.05) was found between LI and the actual doubling time (DT) of the primary tumor mass, evaluated using sequential radiographs. In conclusion, the present BUdR method can be considered a useful source of relevant information on in vivo cell growth, in parallel to other clinical (DT) and biological (DNA content) approaches.

In vitro bromodeoxyuridine labelling of squamous cell carcinomas of the oral cavity

Samples of 33 primary and previously untreated squamous cell carcinomas of the oral cavity were labelled by in vitro bromodeoxyuridine (BURD) incubation. Positive cells were visualized by indirect immunofluorescence antibody labelling. The cells were examined by fluorescence microscopy and the labelling index (LI) was calculated. The values ranged from 0 to 23.2% with a median of 2.6%. The LIs of T3 tumors were significantly higher than those of T1 and T2 carcinomas. The LIs of primary tumors showing cervical lymph node metastases at the time of biopsy also had significantly higher values than tumors without evidence of lymph node involvement. The BURD technique seems to represent a promising tool for studying the clinical implications of the proliferative behavior of human tumors.

Prognostic implications of DNA ploidy in squamous cell carcinomas of the tongue assessed by flow cytometry

A total of 47 primary squamous cell carcinomas of the tongue were analysed by DNA flow cytometry. With respect to their clonal DNA content two distinct tumor groups could be distinguished. In 14 cases the tumors (29.8%) were dipoid, whereas in 33 cases (70.2%) additional cell lines characterized by abnormal DNA content could be detected. A significant increase of aneuploid cases with tumor size as well as with decreasing histological differentiation could be detected. Aneuploid cell lines are lacking in T1 as well as in most G1 carcinomas but predominate in T3 and G3. Furthermore, cervical lymph node involvement was recognized in the majority of aneuploid primary carcinomas (81.8%) but was largely lacking in diploid tumors (21.4%). Hence, the presence of aneuploid cell lines is clearly connected with clinical and histopathological parameters, each of which have turned out to worsen the prognosis in tongue carcinomas.

Rapid in vitro bromodeoxyuridine labeling method for monitoring of therapy response in solid human tumors

In vitro bromodeoxyuridine (BrdUrd) incubated single-cell suspensions obtained from solid tumors were fixed on slides for subsequent sample processing. As dispersal of nuclei largely was avoided, only small amounts of cells were needed for examination. The sensitivity of detecting even low BrdUrd incorporation rates could be improved by treatment with intense DNA denaturation conditions. This technique was applied to monitor cytokinetic response to chemotherapy and radiation in oral carcinomas by analysing biopsies taken consecutively in the course of treatment. By combining BrdUrd labeling and DNA flow cytometry, cells arrested in S phase easily could be distinguished from cells showing continuous proliferation.

The applications of the BrdUrd-technique for the estimation of cycling S-phase cells in human renal cell carcinoma

After testing the BrdUrd technique on experimental tumour cell lines, we applied the technique to human renal cell carcinoma in vitro. We compared the results with the data acquired after FCM analysis and 3H-thymidine treatment. In contrast to BrdUrd the 3H-thymidine uptake seemed to be limited in suspended cells. FCM data represented the DNA distribution of cells. BrdUrd labelling on the other hand detected DNA synthesizing cells. Only both methods in parallel were able to discriminate between proliferating cells and resting cells with an S-phase equivalent DNA content.

Effects of cimetidine upon gastric secretion and mucosal blood flow in the rat stressed by restraint. A dose-response and prophylaxis trial

The effect of the histamine-H2-receptor blocking agent cimetidine (CT) on gastric secretion, mucosal blood flow (MBF), and gastric mucosal stress ulcer index was studied in rats (n = 96) during control conditions (3.9, 15.6, 62.4 microMol/kg/h CT i.p. over 8 h) with calculation of kinetic constants (Vmax; Km) for gastric secretion, MBF and ulcer index, it is shown that CT actions become considerably modified by severe stress. Under mild stress the reduction of MBF and acid secretion by increasing CT doses is parallel. Severe stress alone reduces MBF more than gastric acid (65 vs. 30%). This phenomenon is partly reversed by a dose of 62.4 microMol/kg/h (= 16 mg/kg/h), which is associated with the lowest ulcer index observed. There is no significant correlation between the latter and either acid concentration, acid output, or MBF. The concentrations of pepsin in gastric juice or of serum gastrin neither change with severe stress alone or with additional CT. It is concluded that CT has anti-stress ulcer properties coinciding with reduced acidity in the gastric lumen, but that in addition this beneficial effect may be mediated by factors other than acid reduction.