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Biomedical subjects

D P Bryce

Publications and source records attributed to D P Bryce.

At least 19 recordsLinked to original sources
PubMed1991

Subglottic laryngeal closure for aspiration.

Aspiration may be life threatening, particularly in those patients with severe central neurological disease. From such a group of patients, several were identified who had severe laryngeal dysfunction and aspiration. The majority of patients in this subgroup existed in a neurologically vegetative state. In an attempt to reduce the degree of aspiration they experienced, the procedure of subglottic laryngeal closure was performed. Essentially, the operation is designed to isolate the tracheal airway from the incompetent larynx. The aim is to protect the lower airway from pharyngeal contamination. In all 5 patients there was a marked improvement in general and pulmonary health.

Adult↗
PubMed1987

Functional assessment after laryngotracheoplasty.

Laryngotracheal stenosis is a difficult problem to manage. Functional assessment is measured primarily on the ability to successfully decannulate the patient. In an effort to identify reliable, objective parameters for postoperative functional assessment, we present a retrospective study of 10 postlaryngotracheoplasty patients. All subjects underwent analysis with computerized tomography, translaryngeal manometry, acoustic reflection, flow volume loops (FVL), and voice analysis. Our results led us to conclude that accurate functional assessment is best provided by use of a combination of CT and spectral voice analysis.

Adult↗
PubMed1986

Prognostic significance of thyroid gland involvement in laryngeal carcinoma.

We reviewed 173 laryngeal specimens that included thyroid tissue received from patients undergoing laryngectomy between 1966 and 1980 for evidence of thyroid gland invasion. Twenty-three (14%) of the larynges demonstrated thyroid involvement. In 15 specimens, involvement of the thyroid gland was by direct extension, and in eight the thyroid was involved metastatically. The survival in this group of patients was poor, with 18 patients dying of their disease within three years. Subglottic extension of 10 mm or greater was noted in 21 of 23 patients, and local recurrence was noted in 15 of 18 patients dying of their disease. The importance of removing one or both lobes of the thyroid gland in advanced laryngeal cancer is restated, and a surgically aggressive approach to the paratracheal nodes is recommended in patients with extensive subglottic involvement.

Adult↗
PubMed1985

Primary subglottic carcinoma masquerading clinically as T1 glottic carcinoma--a report of nine cases.

In a clinical and pathological study of patients who had failed radiotherapy for T1 glottic carcinoma, nine patients were encountered who presented with hoarseness, and were considered clinically to have glottic carcinoma at an early stage. Whole organ sections of the laryngectomy specimens showed them to be tumors arising in the subglottic region with involvement of the vocal cord as a late manifestation of their disease. The clinical and pathological features of these nine patients and their tumors are discussed with emphasis on how the diagnosis may be made prior to embarking upon therapy.

Adult↗
PubMed1982

Histopathological study of radionecrosis in laryngeal carcinoma.

With modern radiotherapy techniques, clinical radionecrosis is uncommon following eradication of primary squamous cell carcinoma from the larynx. Histologic sections from 265 specimens, prepared by the technique of whole organ subserial step-sectioning were studied to determine the incidence and location of chondronecrosis and/or osteomyelitis in both irradiated and non-irradiated cases. Chondronecrosis occurred in only 1 of 41 early (pT1 - pT2) tumors but in 143 advanced tumors (pT - pT4) treated with radical radiotherapy and containing residual carcinoma, 27% had evidence of significant necrosis, compared with 24% of those not irradiated. Age, sex, tumor grade and previous laryngeal surgery did not appear to be significant factors in the development of necrosis in irradiated patients. The arytenoid cartilage was most frequently involved when chondronecrosis occurred in association with radiotherapy. Six total laryngectomy specimens (3%) were received from patients with symptoms of chondronecrosis and in whom no residual tumor was present. We conclude that although the incidence of clinical perichondritis is low, histologic chondronecrosis and/or osteomyelitis occurred in 26% of all the larynges studied. Radiotherapy appears to be a significant causative factor only in advanced supraglottic tumors.

Adult↗
PubMed1981

Second primary respiratory tract malignant neoplasms in supraglottic carcinoma.

In this study, a second respiratory tract malignant neoplasm developed in 20 of 163 cases of supraglottic carcinoma either at the time of diagnosis or after diagnosis. Using an actuarial method of calculation, 19% of the survivors will experience a second respiratory tract malignant neoplasm within five years after the diagnosis of supraglottic carcinoma. This is three times the incidence in patients who survive glottic carcinoma and 14 times the incidence in the normal population. A third of this group of patients with supraglottic carcinoma are alive and well at five years, a third died of supraglottic cancer, and a third died of intercurrent disease. The death rate from intercurrent disease is twice that seen in the general population, and this difference is due almost entirely to second respiratory tract tumors. Even if the cure rate of patients with primary supraglottic carcinoma was 100%, only half of these patients would actually be alive at five years, owing to deaths from intercurrent disease. More emphasis needs to be placed on the reduction of the mortality from second respiratory tract tumors with the use of screening or preventive methods.

Glottis↗
PubMed1981

Unique features of head and neck malignancies which relate to their management.

The unique features of head and neck malignancies which relate to their management have resulted in the development of a surgical specialty group for which training criteria have been established. Head and neck tumors are uniquely sensitivity to radiotherapy which provides the surgeon with an alternate method of therapy. They are easily visible and palpable so that the results of therapy can be readily assessed and appropriate treatment protocols developed. Tumors of the head and neck interfere with vital function and present major problems of reconstruction both for cosmetic and functional purposes. Patients with head and neck tumors are remarkably prone to develop second primary malignancies and to have other major physical problems which must be considered. The proper management of head and neck tumors requires a dedicated, knowledgeable team of physicians, nurses, and related personnel working under ideal conditions which allow for the consideration of all the factors uniquely related to malignant disease in the area.

Fistula↗
PubMed1980

Second primary respiratory tract malignancies in glottic carcinoma.

Of 740 cases of glottic cancer, a second respiratory tract tumor developed in 48. Only 14 cases would have been expected in a sample of the same age and sex distribution drawn from the general population of Ontario. Of 25 patients with second tumors in the lung, 23 are dead. Of these 23, 17 had been cured of Stage T1 glottic cancer. An actuarial method for calculating the risk of developing a second respiratory tract tumor amongst the survivors of glottic cancer is described. Of the survivors, 12% will have a second respiratory tract tumor within ten years following initial diagnosis of glottic cancer. Of patients with Stage T1 glottic cancer, 7% will die of a second respiratory tract tumor within ten years. This rate is slightly more than that for those who die of laryngeal cancer in this stage grouping. Late recurrences and/or second primary tumors in the larynx following radiotherapy are rare. Methods for reducing the risk of death from a second respiratory tract tumor are discussed.

Canada↗
PubMed1980

Microvascular surgery.

In situations where existing techniques of reconstruction are inadequate or involve multiple stages, free-flap transfer offers major advantages for the head and neck surgeon. Wider application of free-flap surgery has been inhibited by problems of flap design and graft take. Thrombosis at the microanastomic site, particularly at the venous site, is still a cause of failure. Techniques of anastomosis are of paramount importance. Nakayama ring pin anastomosis is easier to learn, less time-consuming, and shows less early thrombosis that suture techniques. Use of adjunctive pharmacologic agents, such as the tetrahydroimidazo quinazolines, will increase the likelihood of success.

Humans↗
PubMed1980

Management of T3 glottic cancer.

We reviewed 144 cases of T3NOMO glottic cancer. One hundred twelve patients were treated by radical radiotherapy with surgery for salvage (RRSS), and 28 patients were treated by combined preoperative irradiation and laryngectomy. Two patients underwent palliative irradiation, and two patients had surgery alone. Half of the number of patients are alive and well at five years; 30% of the patients died of glottic cancer. No significant difference in crude survival, tumor-related deaths, or deaths from surgical complications was observed between the RRSS group and the combined treatment group. The local control rate by radiotherapy was higher in female patients vs male patients (92% vs 44%); the local control rate was higher in men aged more than 60 years vs male patients who were younger than 60 years (52% vs 34%). Half of the larynges removed in the combined treatment group contained no tumor. We concluded that RRSS, because of its potential to save the larynx and voice, is the treatment of choice in female patients with T3 glottic cancer and is an acceptable alternative to combined treatment in male patients when good follow-up facilities exist.

Age Factors↗
PubMed1980

Primary carcinoma involving the temporal bone: analysis of twenty-five cases.

Twenty-five patients with primary carcinoma involving the temporal bone were reviewed. Pain and discharge were the most common complaints. A history of previous otitis media was found in 64% of the patients. On clinical and radiological assessment, 18 cases were deemed surgically resectable and 7 unresectable. Analysis of treatment revealed 3 groups of patients: an unresectable group of 7 patients treated by primary radical radiation therapy in which there were no long-term survivors; another group received primary radiotherapy with surgery reserved for residual or recurrent disease--4 of this group of 12 survived 4 years or longer; and the remaining group had primary surgery with radical postoperative radiation therapy--4 of this group of 6 patients survived 4 years or longer despite incomplete surgical removal of tumor in all except 1 patient. The results and possible reasons for failure are discussed.

Adult↗
PubMed1980

Radiotherapy of early glottic cancer.

Patients (383) with stage Tis, Tla and Tlb NoMo glottic cancer are reviewed. Radiotherapy cured 93% of Tis patients and 86% of Tla and Tlb cases. Of all recurrences, 63% were cured. No patient with stage Tis died as a result of tumor and only 5% of stage Tla and Tlb died from tumor. Involvement of the anterior commissure or both vocal cords did not influence control rates by radiotherapy. Mobility of the vocal cord and size of radiotherapy field were significant factors influencing control by radiotherapy. Late recurrences and/or second primaries in the larynx following radiotherapy are rare. Second primaries in the respiratory tract (especially lung) are common and are as important a cause of death as laryngeal cancer in T1 cases. It is concluded that moderate dose radiotherapy with surgery for salvage is a highly effective method of management for early glottic cancer.

Evaluation Studies as Topic↗
PubMed1980

Longterm effects of heavy irradiation to the neck.

The longterm effects of heavy irradiation to the neck are now well known. The literature contains reports of major skin contractures, hypothyroidism, laryngeal and tracheal stenosis, major vessel stenosis, and hypoplastic development of cervical vertebrae, but very rarely are all these complications seen in a single patient. Two patients have undergone extensive treatment at the Toronto General Hospital during the past decade for complications of neck irradiation in childhood and their stories should serve as yet another reminder that irradiation, although a major ally in oncological therapy when carefully applied, can be a tool of great destruction when used in excess.

Adult↗