Cases reported "Carcinoma, Squamous Cell"

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1/20. radiation carcinogenesis.

    Accidental or therapeutic exposure to radiation may induce tumors of various histologic types in human beings as well as in animals. Two tumors in this report arose in the organs which had been included in the field of radiation 32 and 8 years before, respectively. The author briefly reviews the literature, which abounds with references to radiation carcinogenesis.
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2/20. Isolated left main coronary stenosis and mediastinal irradiation.

    This report draws an association between mediastinal irradiation and isolated left main coronary artery stenosis. The report highlights two patients who developed selective left main coronary artery stenosis post mediastinal treatment. In the animal model, it has been shown that high serum cholesterol levels at the time of, or soon after, irradiation are necessary to initiate arteriosclerotic plaque formation.
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3/20. Tracheal replacement with an aortic autograft.

    Tracheal replacement after extensive resection remains a challenge for the thoracic surgeon. We propose an innovative solution: the use of an aortic autograft. After an experimental work on animals with aortic autografts and allografts [Martinod E, Seguin A, Pfeuty K, Fornes P, Kambouchner M, Azorin JF, Carpentier AF. Long-term evaluation of the replacement of the trachea with an autologous aortic graft. Ann Thorac Surg 2003;75(5):1572-8; Martinod E, Seguin A, Holder-Espinasse M, Kambouchner M, Duterque-Coquillaud M, Azorin JF, Carpentier AF. Tracheal regeneration following tracheal replacement with an allogenic aorta. Ann Thorac Surg 2005;79(3):942-8], we present the first human case of long tracheal replacement with an aortic autograft. In this case we replaced 7 cm of a tumoral trachea using an aortic infra-renal autograft supported by a silicone stent. The early postoperative course was uneventful. The stent was removed at three months. The patient died at six months from an acute pulmonary infection without any sign of anastomosis leakage or graft rupture. A new field of clinical study has to be investigated.
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4/20. Studies on heat treatment for immediate reimplantation of resected bone.

    Extracorporeal heat treatment for devitalizing the tumour-infiltrated bone segment without destroying its regenerative potential was investigated for the purpose of immediate reimplantation of the resected bone. Effects of heat treatment on cell viability and bone inductive properties were studied in cultured tumour cells and animal models. Heat treatment at 65 degrees C for 30 to 120 minutes resulted in complete devitalization of cells, preserving osteogenetic properties of the allogenic bone implant in the rabbit. The results of the experiments indicate that this procedure has advantages in devitalizing the resected bone for its immediate reimplantation and justify clinical application. The clinical application of this heat treatment in 3 cases is presented.
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5/20. thrombosis-inducing activity found in plasma from two patients with advanced lung cancer.

    In 2 patients with lung cancer, the coagulation system was supposed to be activated by the findings of elevation of plasma fibrinogen, fibrinogen degradation product (FDP) and/or peripheral platelet counts. The plasma thromboxane b2 and 6-keto-prostaglandin F1 alpha levels in 1 patient were measured and proved to be 160 and 20 times higher than the control level, respectively. When 0.5 ml of plasma from each patient was given intravenously into Balb/c mice, the mice died within 5 min. The multiple thrombosis mainly composed of aggregated platelets and present in the lungs of these mice probably led to death of these animals. On the contrary, no such activity was found in plasma from healthy subjects or other patients with lung cancer who showed no manifestations of enhancement in the coagulation system.
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6/20. Laser surgery for vocal cord carcinoma involving the anterior commissure.

    Endoscopic laser surgery is an established means of treatment for benign laryngeal lesions. Laser surgery for early (stages I and II) squamous cell carcinoma is still being tested. Treatment of glottic tumors extending to the anterior commissure is in itself controversial. Approximately 20% of all glottic tumors involve the anterior commissure, with only 1% of these lesions being purely anterior commissure tumors. The anatomy of the anterior commissure is such that an apparent T1 lesion may actually be a T4 lesion if it involves the thyroid cartilage. The distance between the anterior commissure ligament and the thyroid cartilage is only 2 to 3 mm. A preoperative computed tomographic scan can aid us in evaluating this space. Therefore, tumors of the anterior commissure present as a therapeutic challenge. radiation therapy has proven to be inadequate, with a high rate of recurrence and increased risk for radiochondronecrosis. The literature with regard to radiotherapy varies widely as to survival rates. Conservation surgery has consistently demonstrated an 80% survival in T1 lesions. Recently, it has been suggested that laser surgery in the region of the anterior commissure might offer satisfactory results. We have found the opposite. We will report on five patients who underwent endoscopic laser surgery on T1 vocal cord lesions involving the anterior commissure. All of these patients had tumor recurrence and subsequently have undergone salvage surgery and/or radiation therapy. The difficulties associated with endoscopic laser surgery of the anterior commissure will be discussed with a supporting animal study.
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7/20. Porphyrin fluorescence and photosensitization in head and neck cancer.

    Indistinct margin demarcation and autofluorescence are problems in fluorescence delineation of porphyrin-containing head and neck squamous cell cancer (HNSCC). We studied the time course and in vivo localization of porphyrin fluorescence in a squamous cell cancer hamster model and in human HNSCC. After intravenous injection, a gradient in fluorescence intensity developed rapidly until tumors fluoresced above a lower-intensity mucosal background. Hamster tumor and ulcerated HNSCC without porphyrin injection demonstrated autofluorescence grossly indistinguishable from fluorescence in porphyrin-injected tumors. However, fluorescence microscopy revealed autofluorescence to be a surface phenomenon and showed injected porphyrin localized in tumor stroma. We conclude that autofluorescence must be considered when interpreting porphyrin fluorescence. In addition, empirically designed photodynamic therapy can be effective in selected HNSCC. Data from animal experiments provide useful guidelines for the delivery of this therapy.
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8/20. Application of photodynamic therapy in plastic surgery.

    Photodynamic therapy is a technique for administering a sensitizer, hematoporphyrin derivative, which is selectively retained in malignant tissue. This is then activated by light, usually of 630 nm resulting in selective deterioration of the malignant tissue. This technique has been used for detecting and treating a variety of cancers in experimental animals and human beings. In plastic surgery, it has been applied to both basal and squamous cell carcinomas as well as to other skin lesions. Metastatic deposits will also respond to this treatment. Advantages include ease of treatment, sometimes requiring little or no anesthesia, low incidence of reactions, ability to repeat the treatment any number of times, and sparing of normal tissue. Photodynamic therapy has been used as a salvage operation, to clear tissue of suspected or probable remaining malignant disease, and to alleviate the need for a radical operation, allowing a more conservative one. Photodynamic therapy continues to be an investigational tool, and it should be used only as an adjunct to commonly accepted techniques, and then only when needed. Common disadvantages include a severe photosensitivity of the patient for several weeks following administration of the drug as well as inability to treat adequately bulky tumors. New techniques of administration and methods of activation will make this an increasingly common and useful tool in the practice of plastic surgery.
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9/20. Lumbo-sacral radiculopathy induced by radiation.

    Two patients had lumbo-sacral radiculopathy following radiation treatment of cancer. Twenty previously reported cases were similar. The clinical picture is one of progressive motor and sensory loss in the legs, usually appearing within a year after radiation, but sometimes delayed up to several years. Experimental studies quoted indicate greater vulnerability of peripheral nerves to ionizing radiation than has been previously recognized. Lumbo-sacral radiculopathy is readily produced in the experimental animal (rat) and affords an experimental model closely resembling the human cases reported.
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10/20. Experimental model for combination chemotherapy with metronidazole using human uterine cervical carcinomas transplanted into nude mice.

    Human uterine cervical carcinomas (Yumoto strain) and HeLa cell tumors were transplanted into nude mice, and their transplantable strains were established. The fundamental histological features of these tumors were analyzed according to their histological construction and cytological maturation. The effect of administered drugs was examined morphologically. The Yumoto strain is a well-differentiated epidermoid-type carcinoma consisting of regularly arranged basal-type, parabasal-type, and keratinizing-type cells. The HeLa cell tumor is made up of solid medullary carcinoma cell nests in which trabecular arrangements begin to appear around the medullary areas after the third passage. This feature is maintained up to the 17th generation. The basal layer-type cancer cells of the Yumoto strain as well as trabecularly arranged cancer cells in the HeLa cell tumor were selectively influenced by administration of bleomycin and/or mitomycin and showed considerable degeneration or complete disappearance. On the contrary, metronidazole (a drug for vaginal trichomoniasis; Flagyl) displayed a cytotoxic effect on the parabasal-type and/or more mature cancer cells of the Yumoto strain as well as on the solid medullary area of the HeLa cell tumor. This result may indicate a selective affinity of drugs for malignant cells according to their histological construction, and it is conceivable that these types of carcinoma can be affected by combination administration of metronidazole and oncostatic chemicals such as bleomycin and mitomycin. This speculation was realized in this experimental animal research.
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