Biomedical subjects
D G Sessions
Publications and source records attributed to D G Sessions.
AIDS--it won't go away.
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First Aids.
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The doctor-patient relationship.
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Pharyngeal wall cancer. A reappraisal after comparison of treatment methods.
We retrospectively examined 89 patients with pharyngeal wall cancer treated in our institution between 1964 and 1981, to compare the results of treatment after low-dose preoperative irradiation and surgery (R + S) with those achieved with radiation therapy alone (RA). Age, sex, and stage of tumor were comparable for the 41 patients who had R + S and the 34 who had RA. Treatment outcome, survival, and tumor and nodal control were better for the R + S treatment group than for the RA treatment group. Patterns of relapse differed for the two treatment methods and suggested that each might complement the other. Low-dose preoperative irradiation and surgery more often controlled the pharyngeal tumor than did RA, while high-dose irradiation more often controlled nodal disease than did low-dose irradiation and surgery. Our experience suggests that surgical treatment combined with high doses of radiation might improve treatment results for pharyngeal wall cancer.
Staging parameters for cancers of the head and neck: a multi-factorial analysis.
Utilizing a multi-variate computer based analysis technique, the 1,400 case head and neck tumor registry of Washington University was examined for possible staging variables as an alternative to the current TNM system. Site, age, characteristics of surgical margins, and absence of neck node metastasis were identified as being predictive of nonrecurrence of cancer. A computer model utilizing the variables was compared to the current TNM system and found to be somewhat better (71.2% vs. 65.2%) in accuracy of prediction of nonrecurrence of cancer. Further analysis suggests that future improvements in predictive ability of the model will have to await the identification of new variables such as those that might arise from the current work in areas of flow cytometry or human stem cell cultures.
Surgical resection and reconstruction for cancer of the base of the tongue.
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Massive posttonsillectomy hemorrhage.
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Composite resection and reconstruction for oral cavity and oropharynx cancer. A functional approach.
Composite resection, the standard surgical approach for treating cancer of the oral cavity and oropharynx, results in considerable functional and cosmetic deformity, whether primary closure or flap reconstruction is employed. To minimize these problems, an alternate surgical approach has been developed. Essentials of the procedure include use of a non-lip-splitting visor flap for exposure and excision of the lesion, reconstruction with a skin or dermis graft formed into a pouch to fill dead space created by resection, and routine use of intermaxillary fixation for immobilization of the reconstructed area. In 16 patients undergoing this procedure, the approach had no adverse effect on short-term survival. Complication rate with skin and dermis graft reconstruction was acceptably low. Cosmetic improvement has been gratifying. Skin or dermis graft reconstruction has resulted in very satisfactory functional results in terms of tongue mobility, articulation, mastication, and swallowing.
Flap reconstruction in patients with head and neck cancer: techniques and results.
Patients who are treated by surgery, radiotherapy, or any combination thereof may suffer from complications in wound healing or tumor recurrence which necessitate reconstruction of repair utilizing tissue brought in from other parts of the body. The majority of patients, who required flap reconstruction for primary repair or for a complication of their surgery, had their primary lesion in the supraglottic larynx or inferior hypopharynx. More than two-thirds of the flaps elevated were for fistula repair. Five year survival in this group of patients was lower than in those patients with uncomplicated postoperative courses, although the quality of life for the survivors in both groups was not significantly different.
Angiography in the diagnosis and management of extracranial vascular lesions of the head and neck.
The angiographic features of various lesions of the head and neck are presented. Angiographically, cavernous hemangiomas display large venous lakes with calcified phleboliths. Arteriovenous malformations reveal massive tumor stain with well delineated feeding vessels from multiple systems. Chemodectomas and juvenile nasopharyngeal angiofibromas are clearly vascular with homogenous tumor staining in the capillary phase. Angiography of cavernous hemangioma, AVM, chemodectoma, and angiofibroma is diagnostic and may preclude the need for tissue biopsy. Angiographically neurilemmomas are less vascular with non-homogenous tumor stain. Carcinomas are typically avascular. The use and benefits of arterial embolization in the management of these lesions is presented.
Posterior tracheal laceration: A rare complication of tracheostomy.
Tracheostomy is an operation with a long history and many potential complications. Two case reports of acute posterior tracheal wall laceration, a rare complication, are presented. Althoug previously described as being secondary to inadvertent knife contact with the posterior tracheal wall, both of these cases are thought to be due to insertion of the tube with excessive force against tissue made friable by previous radiation. The diagnosis should be suspected if poor ventilation follows insertion of an endotracheal or tracheal tube. The offending tube should be removed and an oral endotracheal tube inserted. After treatment of any accompanying pneumothorax, the site should be evaluated under direct vision as the endotracheal tube is withdrawn proximal to the tracheotomy. If a tear is found, esophagoscopy is performed to insure the integrity of the esophagus. Repair of the tracheal wall is done with a single layer closure through the tracheotomy alternating suturing with ventilation. A generous tracheotomy, soft tubes and care in insertion of tubes into the trachea are suggested preventive measures.
Complications following surgery for cancer of the larynx and hypopharynx.
The hospital and office records of patients undergoing major surgery for cancer of the larynx and hypopharynx at the Washington University Medical Center, St. Louis from 1955 to 1972 were reviewed. Study parameters were correlated with the incidence of major complications and statistically analyzed to elucidate what factors contribute to increased complication rates. Abnormal margins of surgical resection were found to be significant in determining subsequent complication. Age, sex, race, site and stage of the primary tumor, and the presence of pre-treatment cervical lymph node fixation did not alter the rate of complications. Similarly, low dose preoperative irradiation, various forms of carotid artery protection, and surgical patholgic findings including the size of the tumor, number of positive cervical nodes and cellular characteristics of the tumor showed no significant effect on the rate of complications. Increased total complication rate was associated with an increased death rate. Common complications included wound infection, wound necrosis, salivary fistula, hemorrhage, and carotid artery catastrophe. Also considered were operative deaths and delayed fatal complications. The common causes and treatment of these complications are outlined and safeguards which have been valuable in a sizeable number of patients are discussed.
Hypopharyngeal diverticulum.
The diagnosis and surgical management of 26 patients with hypopharyngeal diverticulum treated in the Department of Otolaryngology of the Washington University Medical School from 1961 to 1973 is discussed. The surgical technique for external excision of the diverticulum is described in detail. Results and complications are presented. The surgical excision of hypopharyngeal diverticulum is a standard, safe, and proven method of management which can be expected to result in satisfactory long-term results with minimal morbidity.
Fibrosarcoma of the head and neck in children.
A retrospective study of 11 children with fibrosarcoma of the head and neck is presented. Six of these tumors are well differentiated, and three are poorly differentiated. Nine patients were followed for over six years and are available for treatment evaluation. The results of treatment indicate that patients with superficially located, well differentiated tumors occurring at sites where wide surgical margins can be obtained have the most favorable prognosis.