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Biomedical subjects

D G Sessions

Publications and source records attributed to D G Sessions.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Recent advances in surgery of the larynx and trachea.

Recent advances in surgery of the larynx and trachea have occurred in the general areas of diagnosis, pretreatment nutritional therapy, surgical technique, and reconstruction. In diagnosis the routine use of the flexible fiberoptic laryngoscope in the office and the use of computerized tomography have been valuable. The addition of enteral and parenteral nutrition therapy in selected patients with laryngeal cancer has been an advance. In the area of surgical technique, section of the recurrent nerve for the treatment of abductor laryngeal spastic dysphonia has proved successful. In the area of reconstruction the use of the epiglottic flap for repair of the larynx after near-total laryngectomy for glottic cancer and the use of the pectoralis major myocutaneous flap for one-stage pharyngoesophageal reconstruction have been significant advances. An increase in the number of patients with chronic lung disease has created a new interest in tracheal fenestration.

Enteral Nutrition↗
PubMedDate not supplied

The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus.

The incidence of palpable and occult cancer and the absence of cancer in lymph nodes were determined for individual sites in the larynx and pharynx of 540 patients who underwent neck dissection. The incidence of palpable cancer in lymph nodes was lowest for cancers of the central supraglottis and transglottis (32-41%), intermediate for cancers of the marginal supraglottis and glossoepiglottis (48-57%), and highest for cancers of the pyriform sinus (69%). The incidence of occult cancer in lymph nodes for individual sites in the larynx and pharynx was determined by pathologic study of neck dissection specimens from 253 patients without palpable lymph nodes (NO neck). The incidence of occult lymphatic metastases in the NO neck and the need for elective neck irradiation were least for cancers of the transglottis and central supraglottis (14-16%), intermediate for cancers of the glossoepiglottis and the marginal supraglottis (20-38%), and greatest for cancers of the pyriform sinus (47%). The risk of nodal recurrence increased from 8% for those without cancer in lymph nodes to 38% for those with occult or palpable cancer in lymph nodes. A policy of observing the NO neck in patients with a low incidence of occult lymphatic metastases and a low risk of neck recurrence to avoid the unnecessary irradiation of many to benefit a few is discussed.

Humans↗
PubMedDate not supplied

The risk of contralateral lymphatic metastases for cancers of the larynx and pharynx.

PURPOSE: This study was undertaken to determine the risk of cervical metastases to the contralateral side in patients treated for carcinoma of the larynx and pharynx. PATIENTS AND METHOD: Retrospective evaluation of 846 patients treated between 1962 and 1981 with carcinoma of the supraglottis, transglottis, and pyriform sinus were reviewed. Lesions were classified as either transglottic with fixed vocal cord (TG-F), transglottic with mobile vocal cords (TG-M), central supraglottic (SG-C), marginal supraglottic (SG-M), glossoepiglottic cancers of the suprahyoid epiglottic, vallecula, and tongue base (SG-GE), and cancers of the pyriform sinus (PS). RESULTS: Contralateral lymph node metastases were identified at presentation or later developed in SG-GE 26%, SG-M 14%, PS 13%, SG-C 7%, TG 4%. Contralateral metastases were significantly higher in patients with ipsilateral metastasis. The risk of contralateral metastasis was unrelated to the primary tumor size. CONCLUSIONS: All but 79 patients received variable doses of irradiation to the contralateral neck. Therefore, the risk of metastatic disease is probably higher than reported. Parotid-sparing radiation technique is suggested for centrally located cancers of the supraglottis and transglottis when ipsilateral nodes are not involved because the risk of contralateral neck involvement is sufficiently low that opposite neck irradiation may be safely avoided.

Dose-Response Relationship, Radiation↗
PubMedDate not supplied

Cervical metastasis from an unknown primary.

Summary--Forty-nine patients with cervical metastases from unknown primaries were treated during an 11-year period. Thirty-one (63%) of these patients were treated for cure rather than palliation. The three-year survival rate of these patients treated for cure was 39%. Although the treatment of these patients varied, a systematic mode of therapy has evolved: patients with histopathologic diagnosis of epidermoid carcinoma, or undifferentiated malignant tumor, metastatic to the neck from an unknown primary, are treated with full course radiation therapy (6000-7000 rads at 1000 rads per week). This is delivered to the nasopharynx, pyriform fossae, base of tongue, and the neck, and is followed by radical neck dissection in those patients in whom the neck nodes remain palpable. Six of the last 11 consecutive patients treated in this manner are long-term survivors. This paper describes the evaluation of patients with cervical metastases from unknown primaries as well as their therapy.

Adenocarcinoma↗
PubMedDate not supplied

Enteral and parenteral nutrition in patients with head and neck cancer.

Head and neck cancer patients present with special problems in nutritional homoeostasis because of local phayngeal discomfort and obstruction and difficulty with deglutition due to either the neoplasm or the surgical alterations in the upper aerodigestive tract. Pretreatment malnutrition and vitamin deficiency are only compounded by the nutritional stress imposed by radiation and surgery. Reduced wound complications occur if the patients are nutritionally replenished before treatment. While nasogastric feedings will suffice in many patients, rapid nutritional restoration by this method is limited, and positive nitrogen balance may be difficult to achieve in the severely malnourished patient. Intravenous hyperalimentation offers a rapid and efficacious alternative in selected cases. The case histories of two patients are presented to illustrate these concepts.

Aged↗
PubMedDate not supplied

Extended partial laryngectomy.

This report details the diagnosis and treatment of a patient with a large T3NoMo laryngopharyngeal cancer by combined surgical excision and planned postoperative irradiation therapy. Surgical excision included a horizontal subtotal supraglottic laryngectomy combined with a vertical hemilaryngectomy and partial pharyngectomy. The patient was reconstructed with a free sternocleidomastoid muscle graft. The results and implications of this therapy are discussed.

Follow-Up Studies↗
PubMedDate not supplied

Laser resection for early oral cavity cancer. Results and complications.

Laser excision of early selected cancers of the oral cavity and pharynx is a well accepted and reported treatment. Postoperative radiation therapy is employed in patients with unfavorable pathologic findings and in patients expected to have a high recurrence and metastatic rate. In most patients the combination of laser excision and postoperative radiation therapy is well tolerated and results in satisfactory healing, excellent tumor control, and high-level posttreatment function. This report discusses the treatment and results in 28 patients treated for early cancer of the oral cavity and pharynx. The local control rate of 77% compares favorably with the reported results following either conventional or laser excision of these lesions. The overall complication rate was 39%, with a 25% rate for patients not receiving postoperative radiation therapy, and a 58% complication rate for patients treated with postoperative radiation.

Adult↗
PubMedDate not supplied

Blunt laryngotracheal trauma.

Management of blunt trauma to the larynx and trachea is based upon accurate assessment of the anatomic site of the injury, the tissue involved, the time since the injury, and the general status of the patient. Early and orderly diagnosis and classification result in early management, which is essential to maximize function and minimize morbidity. To evaluate the management and treatment results of patients with blunt trauma to the larynx and trachea, a retrospective study was performed. The office charts and hospital records of all patients with blunt trauma to the larynx and trachea from 1966 through 1976 were reviewed. Conditions studied included etiology of the trauma, initial signs and symptoms, pretreatment findings, management (primary and secondary), complications, and long-term results of management. Management results are discussed in comparison with reported results in the literature, and conclusions are presented regarding optimal treatment for the various classes of laryngotracheal injury.

Airway Obstruction↗
PubMedDate not supplied

Deglutition after conservation surgery for cancer of the larynx and hypopharynx.

Conservation surgery for cancer of the larynx results in deglutition problems. Rehabilitation of swallowing function can successfully be managed by a team including a surgeon, a dietitian, and a nurse. This report details surgical reconstruction to prevent or treat aspiration, postsurgical dietetic management, and the nursing approach to deglutition training in a group of patients.

Deglutition Disorders↗
PubMedDate not supplied

Recurrent carcinoma of the larynx and the hypopharynx.

From a group of 765 patients treated primarily at Barnes Hospital (St Louis) for epidermoid carcinoma of the larynx and the hypopharynx, 199 cases of recurrent disease were identified. To define this group of recurrent carcinoma, the following study parameters were selected: initial site of lesion, initial pathologic condition, initial therapy, complications of therapy, site of recurrence, secondary treatment, and end results. Cause of death is detailed as a result of primary cancer (local, neck, distant, and mixed), complications of treatment, secondary cancer, or intercurrent disease. An attempt is made to correlate the data to understand this anomaly and its responses to therapy better.

Carcinoma, Squamous Cell↗