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Biomedical subjects

B Leipzig

Publications and source records attributed to B Leipzig.

At least 19 recordsLinked to original sources
PubMed1986

Antibiotic prophylaxis in high-risk head and neck surgery: one-day vs. five-day therapy.

Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi-institutional prospective randomized double-blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty-three patients were assigned to 1 day of perioperative prophylaxis. Wound infection developed in ten patients (18.9%). Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P greater than .05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.

Cefoperazone↗
PubMed1985

Assessment of mandibular invasion by carcinoma.

In this prospective study of 31 patients, the most sensitive assessment of malignant invasion of the mandible was by physical examination. Bone scanning and conventional roentgenographs are useful adjuncts in the staging evaluation of patients when clinical involvement is suspected and to determine the extent of disease in order to aid in treatment planning. However, they are frequently subject to false-positive interpretive errors, especially due to increased osteoblastic activity associated with dental disease and occasional tumor adjacent to the mandible. When appropriate, the radiographs ordered should be those that allow for the most accurate assessment of the particular lesion as determined by its location. Until a more specific and accurate method for detecting and measuring malignant invasion of the mandible is developed, the physical findings and the judgment of the head and neck surgeon remains our most valuable tool.

Humans↗
PubMed1985

Cisplatin potentiation of radiotherapy. Long-term follow-up.

Thirty-three patients with inoperable squamous cell carcinoma of the head and neck were treated with cisplatin, 15 mg/sq m, administered synchronously with high-dose radiation therapy. Twenty-nine patients (88%) responded to the regimen; of these, 20 had complete regression of all disease. Eight of the 20 had a relapse in less than one year of their treatment. Among those patients who did not have a relapse, the follow-up period was short. It is concluded that a clinical regression response is more likely with this treatment regimen than with radiation therapy alone, and that that response may be a better palliation. Further study of this combination of treatment modalities is warranted.

Carcinoma, Squamous Cell↗
PubMed1985

The role of endoscopy in evaluating patients with head and neck cancer. A multi-institutional prospective study.

In a prospective multi-institutional study of 384 patients undergoing endoscopy, an 8.9% incidence of second primary neoplasms was discovered simultaneously in the lung (3.3%), esophagus (1.8%), and other head and neck sites (3.6%). The endoscopy was the only source of detection of these tumors in 58% of cases. A trend indicates that flexible fiberoptic bronchoscopy was more effective than rigid bronchoscopy in discovering lung tumors (7.5% vs 2.3%). Nevertheless, the chest roentgenogram remains an important tool in the diagnosis of second primary lesions in the lung. Panendoscopy is safe, takes little time, and can add invaluable information concerning therapy in patients with head and neck cancers.

Bronchoscopy↗
PubMed1984

Sphenoid wing meningioma occurring as a lateral orbital mass.

The differential diagnosis of a mass presenting in the lateral aspect of the orbit with bony erosion and involving the skin includes many malignancies, predominantly sarcomas. A total evaluation of the mass to include histopathologic characteristics and the true extent of the disease is critical to proper management of the patient. A 68-year-old man was referred for therapy with a diagnosis of fibrosarcoma. Evaluation of the disease revealed contiguous tumor from the right temporal region into the posterior orbit, with displacement of the globe and extension intracranially. During operation a frozen section analysis of the tumor was also interpreted as fibrosarcoma. A craniofacial resection was performed, including orbital exenteration and resection of a large 10 X 12 cm segment of attached dura. There was no evidence of extension into the brain. Final pathologic evaluation of the tumor was meningioma rather than fibrosarcoma. This unusual presentation of a meningioma has never been reported in the medical literature. The difficulty with interpretation of the original biopsies will be discussed, as well as the management of this case

Aged↗
PubMed1984

Nasal papillomas and squamous carcinoma.

There is a known association between carcinoma and nasal papillomatosis when benign nasal papillary lesions have been treated by radiotherapy or by chemotherapy. Invasive carcinoma was found in a patient with nasal papillomatosis that had not been treated previously. Ordinary inflammatory polyps involving the nasal and sinus cavities are extremely common and may mask papillomatosis. Polypoid lesions resected from the nasal ans sinus cavities should always be examined histologically.

Carcinoma, Squamous Cell↗
PubMed1983

Cisplatin sensitization to radiotherapy of squamous cell carcinomas of the head and neck.

A combined modality of treatment utilizing cisplatin as a radiosensitizing agent concomitantly with full-course radical irradiation has been studied in 14 patients. Cisplatin at a dose of 15 mg/M2 body surface area was given intravenously on days 1 through 5 and 21 through 25 of the radiation therapy course. Among the 14 patients so treated, 11 patients had evidence of complete clinical regression of their tumors. Most remained in remission without evidence of recurrent disease for as long as 18 months. Recurrence in the field of treatment was even more rare. Symptomatic improvement was very encouraging in these patients. Most of them have had a significant improvement in their tolerance of pain and in the ability to swallow foods and maintain weight without a nasogastric feeding tube. Decannulation of the tracheostomy is usual. Problems included four patients with renal toxicity, one of whom died with renal failure. No patient required interruption of therapy due to mocositis or dysphagia. Nausea was rare. This encouraging data in our pilot study of a new therapeutic regimen justifies a full-scale clinical trial.

Carcinoma, Squamous Cell↗
PubMed1983

Functional evaluation of the spinal accessory nerve after neck dissection.

The pain and dysfunction associated with a loss of innervation by the spinal accessory nerve has motivated surgeons to modify the classic radical neck dissection. A prospective study of 109 patients who underwent either a radical neck dissection or a modification of it with preservation of the spinal accessory nerve revealed that those patients in whom the nerve, muscle, and vein were preserved had less dysfunction (30 percent) than those with nerve preservation only (50 percent) or classic radical neck dissection (60 percent). In addition, even when the functional disability was the same, there was less associated pain with nerve-sparing procedures. Furthermore, a large group of patients (40 percent) who underwent classic radical neck dissection had minimal disability. Given these results, a prospective study of recurrence data in these patients is indicated.

Accessory Nerve↗
PubMed1982

Small cell epidermoid carcinoma of salivary glands. 'Pseudo'-oat cell carcinoma.

Two patients had small cell carcinomas of the salivary glands, with pathological features indicating squamous differentiation, heretofore not described. One is free of disease at seven years, and the second is alive, with regional metastases at four years. Sections from one tumor were studied by electron microscopy and revealed tonofilaments and desmosomes. Most cases of small cell carcinomas of the salivary glands have been considered akin to bronchogenic oat cell carcinoma. Their less aggressive behavior, however, suggests that at least some of these tumors were not true oat cell carcinomas. Our findings, and those of others, indicate that small cell carcinomas of the salivary glands (or head and neck) represent a heterogeneous group. Electron microscopy should be used to determine the exact nature of these neoplasms. If an oat cell nature is ruled out, local and regional treatment should be aggressive, since small cell carcinomas other than oat cell appear not to have a dismal prognosis.

Aged↗
PubMed1982

Use of 1,2:5,6-dianhydrogalactitol in studies on cell kinetics-directed chemotherapy schedules in human tumors in vivo.

Recently, it has been shown that 1,2:5,6-dianhydrogalactitol (DAG) can cause reversible alterations in cell cycle kinetics. Following treatment of CHO cells in vitro and Ehrlich ascites tumor cells in vivo, significant increases in the fraction of cells in S phase were observed to occur, and this was followed by an increase in the fractions of cells in G2 and mitosis. Treatments with S or G2-M phase-specific drugs at the peak enrichment times after DAG was given resulted in greater cell kills than when given by any other schedule. We have extended these kinetics-directed drug schedule studies to human tumors in vivo. The first phase was to determine whether DAG could be used to perturb cell kinetics in vivo as effectively in patients as it was in vitro. In 14 of 17 tumors studied, increases in the S-phase fractions were observed (ranging from 30 to 240% increases). The hr at which the S-phase peaks were observed (post-DAG treatment) was variable among the patients and among the tumors studied. However, this points out the value of obtaining actual cell kinetics data from serially biopsied tumors growing on the body surface and illustrates the importance that these data may have in helping to select an optimal time at which to give an S phase-specific drug. If such tumor cell kinetics-directed scheduling is ultimately shown to be effective, it will represent a means of individualizing therapy for a large fraction of tumor patients whose tumors are growing on or near the surface of the body. The tumors utilized in these studies were squamous carcinomas of the head and neck, skin, anus, and cervix; adenocarcinomas of the breast and rectum; and malignant melanoma. The second phase of this study will be to determine the tumor responses in patients treated with such kinetics-directed schedules.

Adenocarcinoma↗
PubMed1981

Cervical nodal metastases of unknown origin.

A study of 48 patients with metastatic carcinoma in the neck from an unknown primary site has revealed several facts. Among patients with squamous cell carcinoma, the three-year survival rate was 40%. Whether treated with surgery (radical neck dissection) or with radical irradiation alone, the response of these tumors was similar in smaller N1 nodes; when treated with a combined therapeutic approach, they responded well in larger (N2 and N3) cervical nodes. Whether or not the primary tumor was fond did not affect survival rates; the stage of the presenting nodal metastases did not appear to correlate with survival. A large group of patients with adenocarcinoma metastatic to cervical lymph nodes all died of the disease within two years. All appeared with metastases in the supraclavicular fossa; no modality of treatment to the neck, whether by surgery or irradiation, was effective.

Adenocarcinoma↗
PubMed1980

Management of T1 carcinoma of the anterior aspect of the tongue.

The control of carcinoma of the anterior aspect of the tongue is closely related to the extent of the primary tumor and the state of the regional lymph nodes. The most important prognostic factor is the status of cervical lymph nodes; these lymphatic beds should be considered for treatment even in patients who do not have clinically detectable nodal metastasis. Generally, patients with small localized tumors less than 2 cm in diameter (T1) are treated with surgery alone or with radiation therapy alone. In our series, local control was effective in greater than 90% of patients. Treatment failures were most common in the cervical nodes; only 40% of patients with recurrent cervical disease could be cured. The size and differentiation of the lesion, as well as the adequacy of surgical margins, appeared to be related to regional failures. Guidelines are suggested that may aid in selecting patients with T1NO lesions who require elective neck treatment with irradiation.

Carcinoma, Squamous Cell↗
PubMed1980

Replacement of tumor-involved mandible by cryosurgically devitalized autograft: human experience.

In management of a malignant floor-of-mouth tumor invading the mandible, the mandible is the main focus of reconstruction and the most likely site of rehabilitative failure. Creation of a functional and cosmetically appealing replacement is a major therapeutic goal. In canines, neoosteogenesis does occur in mandibular autografts exposed to two consecutive freeze-thaw cycles prior to reimplantation. Also postoperative radiotherapy in canines does not elicit a higher incidence of complications or promote failure of the mandibular autograft to reconstitute itself. This technique was used in a 52-year-old man with a large lesion in the anterior floor of the mouth extending into the inner cortex of the mandible. The theoretical advantages of nonantigenicity and excellence of mandibular configuration are obvious. That there are important pitfalls that may lead to reconstructive failure is equally obvious.

Cryosurgery↗
PubMed1979

A prospective randomized study to determine the efficacy of steroids in treatment of croup.

We evaluated the use of dexamethasone in the management of acute laryngotracheobronchitis (croup). Thirty patients, ranging in age from eight to 60 months, were evaluated in a prospective, double-blind study. Patients received dexamethasone, 0.3 mg/kg at the time of admission and a similar dose 2 hours later, and were compared with a placebo group receiving saline. Sixteen patients received dexamethasone and 14 patients received the placebo. Severity of each group was scored by a standardized system. Patients receiving dexamethasone had a mean admission score of 8.46 points; patients receiving placebo, 8.14. Twenty-four hours after admission the patients in the treatment group had a mean score of 1.19 as contrasted with a score of 5.58 for the placebo group (P less than 0.01). We concluded that dexamethasone when administered in adequate dosage by an intramuscular route hastens the recovery of infants and children with acute uncomplicated croup.

Child, Preschool↗
PubMed1979

Composite resection without mandibular reconstruction.

While composite resection remains the fundamental surgical approach to carcinoma of the posterior oral cavity, removal or reconstruction of the adjacent segment of mandible remains contentious. Various grafts have been used with less than satisfactory and unpredictable results. Bone has been brought in, borrowed, reshaped, and implanted into the area of mandibular deficit; mandibular osteotomy has been attempted with primary closure as well. A review of 78 composite resections at Upstate Medical Center reveals that of this number, 61 have undergone primary lateral mandibulectomy without reconstruction while four others have undergone more extended resection without reconstruction at the time of initial surgery. In the others, mandibular reconstruction has been unsatisfactory; mandibular osteotomy in the presence of irradiated tissue has been unsuccessful in all cases. In our experience, satisfactory results, functionally and cosmetically, have been attained with partial mandibulectomy and primary closure of the wound obviating more involved reconstructive procedures. A review of therapy with attention to surgical detail, complications, and results is presented.

Bone Transplantation↗
PubMed1979

Parotid gland swelling.

The salivary glands are seldom noticed by the physician when they are functioning properly, but they cause vexing problems in diagnosis and management during times of their disordered function. One reason for this is that numerous salivary diseases have similar onsets and patterns of symptomatology. Another reason is that the clinical expression of these diseases is often similar, including pain, diffuse swelling, and altered salivary discharge. This paper enumerates useful points of differentiation which may be elicited from the history and physical examination to distinguish among parotid diseases. If management is to be successful, it must be based on (1) identification of the etiology of the pathologic process, and (2) the institution of therapeutic measures designed to eliminate the etiology of the disease, and restore, as closely as possible, the normal physiology of the gland.

Chronic Disease↗
PubMedDate not supplied

Treatment of cervical lymph nodes in carcinoma of the tongue.

Treatment of the regional lymph nodes forms an integral part of the management of any patient with carcinoma of the tongue. It is the most important determinant of survival. Although survival correlates with the size of the primary tumor, it may also be explained by the higher incidence of metastatic nodes in larger lesions. The incidence of contralateral neck nodes is high, and treatment of the contralateral neck, even in smaller carcinomas of the tongue, must be considered. Anterior tongue carcinomas are equally as aggressive as posterior carcinomas of the tongue. An analysis of the cause of failure following treatment of tongue carcinomas emphasizes the fact that too many clinical stages I and II cancers--those with clinically negative neck examination--are in fact pathologic stage III cancers.

Carcinoma, Squamous Cell↗