Complications after laryngectomy.

The charts of 100 consecutive patients who underwent laryngectomy at Memorial Hospital were reviewed to assess those factors that contribute to postoperative complications. Laryngectomy was performed for epidermoid carcinoma in 94 patients and for laryngeal incompetence in 6. Total laryngectomy was performed in 48 patients and partial and circumferential pharyngectomies in addition to laryngectomy in 40 and 12 patients, respectively.

Gastric transposition in head and neck surgery. Indications, complications, and expectations.

From 1973 through 1982 a total of 63 of our patients had their upper alimentary tracts reconstructed after major ablative neck operations by transposition of the mobilized stomach into the neck through the bed of the resected esophagus. This gastric pull-up procedure was performed without thoracotomy using two surgical teams for resection of locally extensive primary tumors arising in the hypopharynx, cervical esophagus, and thyroid gland. Morbidity and mortality were significant but acceptable.

Studies on the regulation of the biosynthesis of glucose-containing oligosaccharide-lipids. Effect of energy deprivation.

Energy deprivation, induced in thyroid slices by incubation with an uncoupler of oxidative phosphorylation (carbonyl cyanide m-chlorophenylhydrazone) or inhibitors of respiration (N2 or antimycin A), led to a disturbance in oligosaccharide-lipid metabolism which was characterized by a pronounced depletion of the glucosylated (Glc3Man9GlcNAc2) dolichyl pyrophosphoryl saccharide with an attendant accumulation of the Man9GlcNAc2 and, to a lesser extent, the Man8GlcNAc2 lipid-linked species. A concomitant decrease in the N-glycosylation of proteins was furthermore observed. The distribution of lipid-derived oligosaccharides observed by thin layer chromatographic separation was similar whether radiolabeling was achieved by a metabolic ([14C]glucose or [2-3H]mannose incubation) or chemical ([3H]NaBH4) procedure.

Restrictions upon Epstein-Barr virus infection of the leukemic cell are demonstrated in patients with hairy cell leukemia.

We tested the hypothesis that Epstein-Barr virus (EBV) might actually infect leukemic hairy cells in vivo by examining those cells for the EBV-receptor, EBV nuclear antigen (EBNA) and membrane antigen (MA), for spontaneous transformation and rescue of infectious virus and for presence of EBV genome. EBV-receptors were found on subpopulations of leukemic cells from each of 7 patients with hairy cell leukemia (HCL) tested. MA was present on low numbers (1-5 per cent) of fresh leukemic cells of 7 patients and in some instances occurred with a greater frequency after 3 to 5 days in culture, with or without 12-O-tetradecanoylphorbol-13-acetate.

Innominate artery fistula caused by laryngectomy tube.

The patient described illustrates the rare but devastating complication resulting from indwelling tracheal tubes. The innominate artery erosion by the laryngectomy tube in this patient appears pathophysiologically identical to erosion by the tracheostomy tube after routine tracheostomy in other reported cases.

Laryngeal transposition flap for reconstruction of large oral cavity defects.

Resection of the entire tongue and floor of the mouth, with or without the anterior mandibular arch, may necessitate sacrifice of the larynx to prevent life-threatening aspiration and poses a significant reconstructive dilemma. Regional cutaneous or myocutaneous flaps can provide adequate healthy tissue for repair, but share the inherent disadvantage of resurfacing the oral cavity with skin (which may be hair bearing), rather than mucosa. Moreover, cutaneous flaps usually necessitate a planned orocutaneous fistula and secondary closure, and bulky myocutaneous flaps may interfere with oral competence.

Studies on the synthesis and processing of the asparagine-linked carbohydrate units of glycoproteins.

It has become apparent in recent years from the work of a number of laboratories that the N-glycosylation of both membrane and secretory glycoproteins is effected by the transfer en bloc to nascent polypeptides of a glucose-containing oligosaccharide (Glc3Man9GlcNAc2) from a dolichyl pyrophosphoryl carrier; this is followed by a series of modifying reactions to yield the mature polymannose and complex asparagine-linked carbohydrate units. The enzymic steps involved in the assembly of the precursor oligosaccharide, its transfer to protein and its subsequent processing represent potential sites for the regulation of glycoprotein synthesis. Studies performed in our laboratory have dealt primarily with thyroid slices and particulate enzymes with special regard to the role of glucose in these events.

Lens epithelial cell adhesion to lens capsule: a model system for cell-basement membrane interaction.

Adhesion of calf lens epithelial cells to lens capsule, their natural basement membrane was found to be considerably more rapid than either to plastic or to type I or type IV collagen coated surfaces. No polarity of the basement membrane was observed as the cells were able to attach to either side of the anterior or posterior lens capsule; a prerequisite for adhesion to the lenticular side of the anterior capsule was the prior removal of its epithelial cell layer. The attachment was energy-dependent and required calcium and magnesium ions, but was not enhanced by the presence of serum.

Adenocarcinoma of salivary origin. Clinicopathologic study of 204 patients.

We have reviewed a 30 year experience with 204 patients treated for adenocarcinomas of salivary origin. Seventy-one percent had histologically typical adenocarcinomas, whereas 12 percent had papillary, 12 percent mucinous, and 5 percent other unusual variants. Despite these morphologic differences, almost all of the lesions could be classified into one of three histologic grades.

Effect of diabetes on the glycosaminoglycan component of the human glomerular basement membrane.

The glycosaminoglycan (heparan sulfate) component of glomerular basement membranes from human kidneys of diabetic and nondiabetic subjects has been quantitated after isolation from protease digests of the membranes on DEAE-cellulose microcolumns. A significant decrease (P less than 0.005) in the glycosaminoglycan content of diabetic membranes was observed.

Differences in synthesis of membrane proteins by leukemic cells from spleen and peripheral blood indicate distinct subsets of malignant cells in a patient with prolymphocytic leukemia.

Morphological and biochemical differences were demonstrated between prolymphocytic leukemia cells obtained from the spleen and peripheral blood of one patient. Peripheral blood prolymphocytes had consistently smaller nuclear-cytoplasmic ratios than did splenic prolymphocytes. Percoll gradient-purified prolymphocytes from the spleen synthesized abundant amounts of some membrane proteins which were hardly expressed by peripheral blood prolymphocytes.

Mandibular "swing" approach for oral and oropharyngeal tumors.

This study reviews the history, indications, and operative technique for median mandibulotomy with paralingual extension (mandibular "swing"). A 21-year experience is presented, during which this operative approach was used in 49 patients with tongue cancer and 16 others with oropharyngeal lesions. Mandibular "swing" appears to offer more versatility and fewer problems than either median labiomandibular glossotomy or lateral mandibulotomy.

Comparative studies on amniotic fluid and plasma fibronectins.

Human fibronectin was isolated from second-trimester amniotic fluid, from amniotic fluid obtained at term and from adult plasma. The amniotic-fluid fibronectins had a slightly higher apparent molecular weight on sodium dodecyl sulphate/polyacrylamide-gel electrophoresis than the plasma fibronectin. Early- and late-amniotic-fluid fibronectin had 9.

Elective postoperative radiation therapy in stages III and IV epidermoid carcinoma of the head and neck.

One hundred five patients with advanced (American Joint Committee stages III and IV) but resectable epidermoid carcinoma of the head and neck were treated with radical surgery and elective postoperative radiation therapy. Follow-up periods range from 16 to 66 months. Nineteen patients (18 percent) have had recurrence in the head and neck area.

Carcinoma of the cheek mucosa. A retrospective analysis.

A 16 year experience with 121 patients treated for squamous cell carcinoma arising in the cheek mucosa is described. Treatment was almost exclusively surgical, and 5 year determinate cure rates ranged from 77 and 65 percent in stage I and II lesions to 27 and 18 percent in those with stage III and IV lesions, respectively. Twenty-four percent of previously treated patients remained alive and well at 5 years.

Isolation and characterization of three major glycoproteins from thyroid plasma membranes.

Three major glycoproteins of calf thyroid plasma membranes were preferentially solubilized by chloroform/methanol extraction and recovered along with glycolipids in the aqueous phase. After removal of lipid from this extract, a fraction was obtained which accounted for about 20% of the carbohydrate of the membrane but only 2% of its peptide weight. Partial resolution of the components could be achieved by filtration on Bio-Gel A-5m, while preparative polyacrylamide gel electrophoresis resulted in the isolation in homogeneous form of approximately equal amounts of the three glycoproteins which were designated as GP-1, GP-2, and GP-3, in order of their increasing mobility.

Membrane expression and synthesis of p23,30 (HLA-DR antigen) by human peripheral blood monocytes.

The synthesis and expression of protein complexes of 23,000 and 30,00 dalton (p23,30) HLA-DR antigen, and of 44,000 and 12,000 dalton (p44,12) HLA-A,B antigen and beta 2-microglobulin was demonstrated on human peripheral blood monocytes and in cultures of purified, adherent monocytes. In indirect immunofluorescence assays, a gradation in the intensity of staining with rabbit anti-p23,30 serum was present but clearly p23,30-negative, actively phagocytic monocytes were not found. In contrast the fluorescence intensity of staining with a serum to p44,12 (HLA-A,B antigens and beta 2-microglobulin) was constant on all macrophages.