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- McNemar with unequal sample sizes

Hi,

i need to test the equality of proportions in a paired case, like here:
	
after	before
	+	-
+	10	14
-	5	53

So usually i use the mcnemar.test(stats).

Due to mortality, I now got the problem that my sample sizes in both
factors are not equal any more -- there are less cases in the "after"
condition. I already learned that Ekbohm (1982) and Marascuilo adressed
the problem conceptually, but I'm not that good at writing my own
functions.

Can anyone give me a hint what function/test/package in R to use?

Thank you very much for your help,
Christian