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Biomedical subjects

D E Schuller

Publications and source records attributed to D E Schuller.

At least 19 recordsLinked to original sources
PubMed1992

Prophylactic antibiotics for head and neck surgery with flap reconstruction.

The leading cause of postoperative morbidity in patients undergoing major head and neck surgical procedures is postoperative infection. This prospective randomized multi-institutional clinical trial was designed to compare the effectiveness of clindamycin phosphate and high-dose cefazolin sodium therapy in preventing postoperative wound sepsis in patients undergoing contaminated head and neck surgical procedures in which flap reconstruction was required. Either clindamycin phosphate (900 mg) or cefazolin sodium (2 g) therapy was instituted intravenously prior to surgery and continued every 8 hours, for a total of 24 hours. The patients received postoperative follow-up, and the wounds were graded according to the worst condition observed. One hundred cases were evaluated. Fifty-one patients received clindamycin and 49 patients received high doses of cefazolin; wound infection developed in 10 patients (19.6%) and 11 patients (21.6%), respectively. This difference was not statistically significant. The average duration of surgery was approximately 8 hours for both the infected and the noninfected groups of patients. High-dose cefazolin and clindamycin have similar efficacy when administered prophylactically under these circumstances. Reconstruction with free vascularized tissue may aid in reducing postoperative wound infection.

Cefazolin↗
PubMed1992

Surgical and prosthetic considerations in the management of orbital tumors.

Since tumors of the globe and ocular adnexa, other than skin cancers of the eyelid, are uncommon, most oncologic specialists have little opportunity to become experienced in the management of eye tumors. In general, a malignancy that does not penetrate a bony orbital wall can be resected with an adequate margin by inclusion of the adjacent wall and periorbita. The decision to save or sacrifice a globe when a malignancy penetrates the bone but not the periorbita should be based on such factors as the tumor histology, contralateral vision, the probability of permanent diplopia, and the need for irradiation in doses that would destroy vision. Because of the complications involved with irradiation of orbital tumors, surgical resection has been the treatment of choice. In addition, orbital exenteration presents a unique challenge to the maxillofacial prosthodontist. Prosthetic restoration of the orbit is often complicated by the extent of resection, tissue response, and method of retention.

Humans↗
PubMed1992

Adjuvant chemotherapy for resectable squamous cell carcinomas of the head and neck: report on Intergroup Study 0034.

To test the efficacy of sequential chemotherapy as an adjuvant to surgery and postoperative radiotherapy for patients with locally-advanced but operable squamous cell cancers of the head and neck region, a randomized clinical trial was conducted under the auspices of the Head and Neck Intergroup (Radiation Therapy Oncology Group, Southwest Oncology Group, Eastern Oncology Group, Cancer and Leukemia Group B, Northern California Oncology Group, and Southeast Group). Eligible patients had completely resected tumors of the oral cavity, oropharynx, hypopharynx, or larynx. They were then randomized to receive either three cycles of cis-platinum and 5-FU chemotherapy followed by postoperative radiotherapy (CT/RT) or postoperative radiotherapy alone (RT). Patients were categorized as having either "low-risk" or "high-risk" treatment volumes depending on whether the surgical margin was greater than or equal to 5 mm, there was extracapsular nodal extension, and/or there was carcinoma-in-situ at the surgical margins. Radiation doses of 50-54 Gy were given to "low-risk" volumes and 60 Gy were given to "high-risk" volumes. A total of 442 analyzable patients were entered into this study with the mean-time-at-risk being 45.7 months at the time of the present analysis. The 4-year actuarial survival rate was 44% on the RT arm and 48% on the CT/RT arm (p = n.s.). Disease-free survival at 4 years was 38% on the RT arm compared to 46% on the CT/RT arm (p = n.s.). At 4 years the local/regional failure rate was 29% vs. 26% for the RT and CT/RT arms, respectively (p = n.s.). The incidence of first failure in the neck nodes was 10% on the RT arm compared to 5% on the CT/RT arm (p = 0.03 without adjusting for multiple testing) and the overall incidence of distant metastases was 23% on the RT arm compared to 15% on the CT/RT arm (p = 0.03). Treatment related toxicity is discussed in detail, but, in general, the chemotherapy was satisfactorily tolerated and did not affect the ability to deliver the subsequent radiotherapy. Implications for future clinical trials are discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study.

PURPOSE: The Southwest Oncology Group (SWOG) conducted a randomized comparison of cisplatin plus fluorouracil (5-FU) and carboplatin plus 5-FU versus single-agent methotrexate (MTX) in patients with recurrent and metastatic squamous-cell carcinoma (SCC) of the head and neck. The primary objective was to compare separately the response rates of each combination regimen to standard weekly MTX. PATIENTS AND METHODS: Two hundred seventy-seven patients diagnosed with SCC of the head and neck were randomized to one of three treatments: (1) cisplatin 100 mg/m2 intravenously (IV) on day 1 and 5-FU 1,000 mg/m2 per day for a 96-hour continuous infusion repeated every 21 days; (2) carboplatin 300 mg/m2 IV on day 1 and 5-FU 1,000 mg/m2 per day for a 96-hour continuous infusion repeated every 28 days; and (3) MTX 40 mg/m2 IV given weekly. RESULTS: All three treatment regimens were well tolerated. However, both hematologic and nonhematologic toxicities were significantly greater with cisplatin plus 5-FU compared with MTX (P = .001). Toxicity from carboplatin plus 5-FU was intermediate compared with the other regimens. The complete and partial response rates were 32% for cisplatin plus 5-FU, 21% for carboplatin plus 5-FU, and 10% for MTX. The comparison of cisplatin plus 5-FU to MTX was statistically significant (P less than .001), and the comparison of carboplatin plus 5-FU to MTX was of borderline statistical significance (P = .05). Median response durations and median survival times were similar for all three treatment groups. Logistic regression models showed that only treatment assigned was associated significantly with response (P = .001). Cox proportional hazards models indicated that only performance status was associated significantly with survival (P less than .01). CONCLUSIONS: We conclude that combination chemotherapy resulted in improved response rates but was associated with an increased toxicity and no improvement in overall survival. Therefore, new treatments that may alter the course of disease in recurrent head and neck cancer patients still need to be identified.

Adult↗
PubMed1992

Analysis of risk factors for postoperative pulmonary complications in head and neck surgery.

Preoperative pulmonary function tests (PFTs) are unproven in their predictive value for postoperative pulmonary complications. There is a lack of prospective outcome studies upon which to form an opinion, particularly regarding noncavitary surgery. Seventy-three head and neck surgery patients were prospectively evaluated with preoperative PFTs, arterial blood gas analysis (ABG), medical history, and physical examination. Age, anesthesia duration, forced expiratory volume in 1 second (FEV1), peak flow (PF), PaO2, Roizen class, and pack years of smoking were significantly correlated with postoperative pulmonary complications. As similar studies in head and neck surgery patients have not been previously taken, it is hoped that these results will serve as a basis for future endeavors.

Age Factors↗
PubMed1992

Maxillary removal and reinsertion for improved access to anterior cranial base tumors.

Portions or all of the maxillae are oftentimes removed solely to provide access to certain cranial base tumors rather than because they are involved directly with disease. The purpose of this report is to describe an approach that involves removal of one or both maxillae to improve tumor exposure with subsequent reinsertion as free bone grafts which are stabilized with titanium craniofacial fixation plates. The titanium permits postoperative imaging studies and radiotherapy. Eleven patients ranging from 10 to 69 years of age have undergone 12 operations using this technique for resection of 4 benign and 8 malignant tumors at The Ohio State University. Seven of the 8 patients with malignancies underwent postoperative radiation therapy. There have been no permanent complications and no evidence of bone resorption in this group after follow-up of up to 15 months.

Adolescent↗
PubMed1992

Flutamide-induced regression of angiofibroma.

Juvenile nasopharyngeal angiofibroma (JNA) appears to be an endocrine-responsive tumor. This concept was tested in five young men with JNA by treating them with a testosterone receptor blocker (flutamide) for 6 weeks preoperatively. Tumor size was evaluated by axial computed tomography both before and after flutamide therapy. Four of the five patients had an average tumor shrinkage of 44%. The patients tolerated the drug well, and the serum testosterone levels 2 or more years posttherapy were normal. This pilot study demonstrate that preoperative hormonal pharmacoreduction of JNA is a feasible adjunct to surgical therapy that offers the possibility of reduced blood loss. However, the authors believe that a formal clinical trial of this treatment approach is warranted and should be done before widespread adoption of this agent.

Adolescent↗
PubMed1991

Do otolaryngologist-head and neck surgeons and/or chemotherapy have a role in the treatment of head and neck cancer?

We provide an update on the current status of chemotherapy in the treatment of head and neck cancer. The role of the otolaryngology--head and neck surgeon in this important clinical research is underscored. Those involved with treating patients with head and neck cancer must understand the mechanisms of clinical cancer research. Physicians in academic and community settings can be intimately involved in this treatment.

Antineoplastic Agents↗
PubMed1991

Histopathologic comparison between human oral squamous cell carcinomas and their xenografts in nude mice.

Tumor portions were obtained from 11 oral squamous cell carcinomas and used to produce tumors in a xenogeneic gnotobiotic nude mouse model system. The tumors that developed were examined histologically. The cellular features and tumor growth patterns were compared between the original oral squamous cell carcinoma (T0) and the tumor that developed in the xenogeneic host (T1). The T1 tumors were more highly differentiated in comparison with the T0 tumors. The T1 tumors exhibited less cellular pleomorphism and a more uniform pattern of stratification. The cells in the T1 tumors exhibited an increased mitotic index but did not contain abnormal mitoses. The T1 tumors usually exhibited nodular growth patterns rather than the infiltrating pattern exhibited by the parenchyma of the T0 tumors. The desmoplastic reaction was markedly reduced in the T1 tumors. The results indicated that the gnotobiotic nude mouse model system either selects for or induces a more differentiated pattern of tumor growth than that found in the original human oral squamous cell carcinomas.

Adult↗
PubMed1990

Nonpigmented papillary carcinoma in a black thyroid gland.

A case of papillary thyroid carcinoma occurring in a 27-year-old man with black thyroid syndrome is reported. The tumor, in contrast to the remaining thyroid, was not pigmented. The significance and potential utility of the differential pigmentation are discussed.

Adult↗
PubMed1990

Poorly differentiated ('insular') thyroid carcinoma. Report of two cases and review of the literature.

The clinical, histopathologic, immunohistochemical, and electron microscopic findings of two cases of poorly differentiated ("insular") thyroid carcinoma are reported and compared with the 25 cases previously described in the literature. These 27 cases occurred in eight men and 19 women, aged from 34 to 77 years. All but 2 presented with a thyroid mass. Eleven (41%) of the 27 patients experienced local recurrences following surgery, 17 (63%) had development of cervical lymph node metastases, 5 (19%) had development of mediastinal lymph node metastases, 11 (41%) had pulmonary metastases, and 9 (33%) had bone metastases, and 9 (33%) had bone metastases. At least 15 patients (56%) are known to have died of their disease, usually within 8 years of diagnosis. Pathologically, the tumors are distinctive and grow as solid islands (insulae) of small cells separated by artifactually created clefts. In some instances, small follicles are also noted within the insulae. All tumors were positive on immunostaining for thyroglobulin. In view of the propensity for local recurrences and lymphatic and hematogenous dissemination, a total thyroidectomy and neck dissection would seem advisable. Additionally, adjuvant external beam irradiation, systemic chemotherapy, and/or radioactive iodine therapy should also be considered.

Adenocarcinoma↗
PubMed1990

Improving diagnostic accuracy of cervical metastases with computed tomography and magnetic resonance imaging.

Elective neck dissection in patients with head and neck cancer continues to be controversial. The management of these patients would be greatly facilitated by improvements in predicting cervical metastases. Recent investigations have suggested that computed tomography and magnetic resonance imaging are more sensitive in detecting cervical metastases than physical examination. The Department of Otolaryngology at the Ohio State University Hospitals, Columbus, undertook a prospective study to compare the preoperative sensitivities of physical examination, computed tomography, and magnetic resonance imaging with pathologic findings in 27 patients undergoing neck dissections for head and neck cancer. The results indicate that computed tomography and magnetic resonance imaging were more sensitive (84% and 92%, respectively) than physical examination (75%), although the results did not achieve statistical significance. The sensitivity of combined computed tomography and magnetic resonance imaging was 90%.

Head and Neck Neoplasms↗
PubMed1990

Evaluation of voice by patients and close relatives following different laryngeal cancer treatments.

The purpose of this study was to assess perception of life style change among laryngeal cancer patients. Seventy-five patients (total laryngectomy 35, supraglottic laryngectomy 15, hemilaryngectomy 12, radiotherapy eight, laser cordectomy five) and close relatives responded to a questionnaire and interview eliciting perception of: 1) posttreatment voice quality; 2) side effects of treatment vocationally and socially; and 3) degree of vocal or communicative change associated with vocational or social change. Whereas 43% of the patients reported vocational change and 37% reported social change, 88% expressed satisfaction with their posttreatment voices. This may have been due to the perceptions of the relatives, who generally had a more positive view of the patients' voices. Although laryngeal cancer had an impact on patient life style, patients seldom related this to vocal dysfunction.

Employment↗
PubMed1990

A multicenter trial of nedocromil sodium, 1% nasal solution, compared with cromolyn sodium and placebo in ragweed seasonal allergic rhinitis.

This study was a double-blind, parallel-group study to evaluate a new medication, nedocromil sodium, 1%, in comparison with placebo and cromolyn sodium, 4%, for treatment of ragweed seasonal allergic rhinitis. Two hundred thirty-three patients (aged 12 to 65 years) from eight centers were randomized to treatment, one spray per nostril, four times daily, with nedocromil sodium, cromolyn sodium, or matched placebo (80, 76, and 77 patients, respectively). All patients had at least a 2-year history of ragweed seasonal allergic rhinitis. Treatment was for 8 weeks during the ragweed season, and daily pollen counts were used to identify the peak 3-week period. Clinic examinations were made before and after the 1-week baseline and after 1, 3, 5, and 8 weeks of treatment. Rhinitis symptoms were recorded each day by the patients. Nedocromil sodium was more effective than placebo (p less than 0.05) in relieving symptoms as recorded by the patients. Cromolyn sodium was also more effective than placebo, but the difference was not usually significant. Similarly, the active treatments were both better than placebo for clinical parameters measured at visits and for global opinions of treatment, and more rescue therapy was used by the placebo-treated group. There was no significant difference between the two active treatments, but the trend throughout was in favor of nedocromil sodium. Our findings demonstrated nedocromil sodium to be at least as effective as an established therapy (cromolyn sodium) in reducing symptoms of rhinitis during the peak ragweed pollen season.

Adolescent↗