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Biomedical subjects

C E Silver

Publications and source records attributed to C E Silver.

At least 55 records · Page 3Linked to original sources
PubMed1976

Reconstruction after pharyngolaryngectomy-esophagectomy.

Seventeen patients with carcinoma of the hypopharynx and/or cervical esophagus who require total pharyngolaryngectomy-esophagectomy are presented; Twenty-one different reconstructive methods were applied in the seventeen patients. An overall two year survival rate of 35 per cent was attained with effective palliation in 65 per cent of the patients. The Wookey and free jejunal transplantation procedures were unsuccessful as primary means of pharyngoesophageal reconstruction, although the Wookey principle was occasionally useful in salvaging failures of other procedures. The reversed deltopectoral flap was successfully employed in a small number of patients with only minimal extension below the cricopharyngeus but was found to be unfeasible in several other instances because of the extent of esophageal resection required. Transposition of the entire stomach was successfully employed in a number of suitable patients and is an excellent method of esophageal replacement in relatively healthy patients. The reversed gastric tube esophagoplasty was useful in more debilitated patients, with resection and reconstruction performed in separate stages.

Esophageal Neoplasms↗
PubMed1976

Gastric pull-up operation for replacement of the cervical portion of the esophagus.

The gastric pull-up operation is a useful, effective method for immediate restoration of alimentary continuity after resection of the larynx, pharynx and esophagus for carcinoma of the hypopharynx or cervical portion of the esophagus or both. It is suitable only for those patients whose general condition is sufficiently satisfactory to tolerate the one stage combined abdominal cervical operation. When successfully used, the results are striking in comparison with those usually obtained from other methods of esophageal reconstruction.

Esophageal Neoplasms↗
PubMedDate not supplied

Pectoralis myocutaneous flap for replacement of cervical esophagus.

The authors report experience with 10 cases of pharyngoesophageal replacement with tubed pectoralis major myocutaneous (PM) flap. Six patients had primary reconstruction following total pharyngolaryngectomy for cancer; the other 4 had severe pharyngoesophageal stenosis requiring resection and replacement following previous laryngectomy. Seven of the patients were octogenarians, 6 had been irradiated previously, and all were severely debilitated. Two patients died postoperatively of cardiac disease. The remaining eight regained satisfactory with lasting deglutition. Four fistulae healed spontaneously, and one postoperative stenosis responded to a single dilitation. The interval to swallowing was 10-21 days in nonirradiated patients and 3-13 weeks in irradiated patients. There was one local recurrence 6 months after resection; the other patients remained free of disease. The authors conclude that the tubed PM flap is a reliable technique for pharyngoesophageal reconstruction that is particularly useful in elderly and debilitated patients.

Aged↗
PubMedDate not supplied

Computed tomography of the clinically negative neck.

Members of the New York Head and Neck Society conducted a multi-institutional review correlating preoperative computed tomography (CT) of the neck with postoperative pathology in 59 patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx, without palpable lymphadenopathy. All underwent CT followed by surgery that included partial or complete cervical lymphadenectomy. Sixteen (28%) patients had occult cervical metastases including 6 (17%) of 36 patients with "early stage" (T1 and T2) primary tumors and 10 (44%) of 23 patients with "advanced" (T3 or T4) lesions. There was agreement of CT scan findings with presence or absence of metastatic disease in 41 (69%) of 59 studies, with sensitivity 38%, and with specificity 81%. Findings of central lucency and nodal confluence were highly reliable indicators of malignancy, whereas nodal size bore a less direct relationship. Intravenous contrast medium was useful for anatomical delineation, but not for identification of malignancy. Review of films by a single radiologist did not produce greater diagnostic accuracy than the original interpretations. The authors conclude that while it is not possible to identify all instances of cervical node involvement, employment of CT in addition to physical examination and prognostication based on primary tumor stage will facilitate appropriate selection of patients for elective treatment of the neck.

Carcinoma, Squamous Cell↗