Biomedical subjects

G L Schechter

Publications and source records attributed to G L Schechter.

At least 37 records · Page 2Linked to original sources

PubMed1986

Management of panesophageal cancer by blunt resection without thoracotomy and reconstruction with stomach.

Encouraged by their experience since 1978 with blunt esophagectomy and gastric reconstruction in the management of pharyngolaryngeal malignancy, the authors have extended their use of this technique to the management of thoracic esophageal cancer. A study of 43 blunt esophageal resections is presented; 23 were performed in the management of pharyngolaryngeal cancer, and 20 were performed (22 attempted) for the resection of intrathoracic esophageal cancer. In the first group, two deaths occurred secondary to liver failure in cirrhotic patients with moist ascites. One death occurred due to anastomotic leak in the neck of a patient with laryngeal cancer treated with extended mediastinal dissection and tracheal resection for surgical and radiation failure. Two tracheal injuries occurred; one could be managed through the neck, and one required thoractomy for repair. In the 20 resections performed for intrathoracic cancer, there were no deaths, no tracheal injuries, and one chest was explored for bleeding in the splenic bed, which decompressed itself into the right chest. The overall mortality was 7.5%. The evaluation emphasizes: The applicability of this technique for the management of esophageal problems at all levels. The safety of the technique, particularly in the typical population with advanced aged and severe underlying medical illness. Good functional results with palliation and/or cure. The benefit of intact mediastinal pleura in avoiding certain thoracic complications. The authors conclude that blunt esophagectomy is a safe resection procedure with limited morbidity and mortality, and that gastric reconstruction is reliable and affords excellent functional results. They are encouraged to continue management of panesophageal cancer with this technique.

Actuarial Analysis↗

PubMed1985

Macroglossia: etiologic considerations and management techniques.

Tongue enlargement of varying degrees occurs in many people and often requires no therapy. However, marked tongue enlargement, when present, requires direct intervention. In this case, the otolaryngologist is presented with a dilemma, for the etiology of the problem is often obscure. In many cases, the tongue enlargement is secondary to systemic disease, and medical management is indicated. When tongue reduction is indicated, there are many modalities available. Of these, only excision offers an acceptable functional result with minimal morbidity. Even large protuberant tongues can be reduced with minimum difficulty. The type of tongue excision can be tailored to the involved area and to special patient requirements. The problem of macroglossia is explored and management techniques are reviewed to present an alternative for optimal management of the enlarged tongue.

Acromegaly↗

PubMed1984

Voice quality and intelligibility characteristics of the reconstructed larynx and pseudolarynx.

The ideal laryngeal substitute would provide a voice with good intelligibility, volume, and character. The basic components of these qualities are being studied in our laboratories to refine laryngeal reconstruction and replacement techniques. Exact definition of these characteristics may then be translated into specific requirements for reconstruction. In this study the phonation of laryngectomees using hand-held artificial laryngeal devices and patients with reconstructed larynges was compared with that of normal speakers. Presentations were evaluated by adult listeners with normal voice and hearing, and intelligibility scores were developed. These studies show, in part, that the fundamental frequencies at which various artificial speech aids are used do not significantly correlate with user intelligibility. Computerized spectral analysis was then utilized to ascertain the unique acoustic characteristics of the voices. Further computer analysis was carried out to determine what characteristics of the normal speakers' voices were shared in common with patients using artificial devices and patients with reconstructed larynges. Initial attempts at using these findings in laryngeal reconstruction based on computer modeling will be presented.

Humans↗

PubMed1984

Care of the professional voice.

Care of the professional voice patient requires the skills of a general physician and those of the specialist combined in one person. The physician must have a good working knowledge of the anatomy, physiology, and pharmacology of the vocal tract. These patients require special understanding, assistance from a voice therapist, and, above all, time.

Acute Disease↗

PubMed1984

Conservation surgery of the larynx--when?

This presentation has dealt with the question of when to perform conservation surgery of the larynx for cancer. The authors included a recommendation for the use of radiotherapy because it is an obvious extension of the issue. It should be clear that this is a complex problem involving relatively few patients compared with the number of radiation therapists and head and neck surgeons throughout the country. Eligibility for conservation surgery of the larynx is dependent upon many factors in addition to the gross extent of the tumor. Since radiation will be one of the choices of therapy, it is imperative that the head and neck surgeon dealing with these problems have an excellent working relationship with a radiation oncologist. A surgical pathologist with a specific interest in head and neck diseases is a required member of the team. As with any other team endeavor, no one member can assume that his talents alone can win the game.

Consumer Behavior↗

PubMed1983

Complications of flaps and grafts in the oral cavity and pharynx.

A study has been presented which was designed to determine the complications of flaps and grafts in oral cavity and pharyngeal reconstruction. The complications are related to three basic areas: 1. pre and postoperative metabolic and nutritional considerations, 2. flap or graft choice and design at the site of reconstruction, and 3. basic surgical technique in exposure, resection and flap handling. Ways to avoid these complications have been discussed.

Articulation Disorders↗

PubMed1983

Epiglottic reconstruction and subtotal laryngectomy.

Vertical hemilaryngectomy has been expanded aggressively in recent years so that, in some cases, the term subtotal laryngectomy would be more appropriate. Reconstruction after these extended resections is a problem. Intraluminal stenting has not been successful in cases where resection has been aggressive. The resulting lumen is inadequate. As a means of overcoming this problem, the epiglottic reconstruction procedure has been promoted. This paper presents experiences with 12 patients who underwent epiglottic reconstruction after subtotal laryngectomy. Indications, anatomic details, and overall results using this reconstructive technique are outlined. It is the conclusion of the author that epiglottic reconstruction is an effective procedure for preservation of function after subtotal laryngectomy.

Adult↗

PubMed1982

Changing face of treatment of peritonsillar abscess.

Changing trends in the treatment of peritonsillar abscess are demonstrated by this retrospective study of 74 patients treated from 1975 through 1980 by a standardized regimen. This included needle aspiration at three points, intravenous antibiotics, hydration, and pharyngeal douches. The patients ages ranged from 11 to 73 years. There were 45 males and 29 females. Needle aspiration was positive in 52 patients (70%) and repeat aspiration was necessary in 10% of patients. Tonsillectomy was performed in 42 patients. No recurrent peritonsillar abscesses occurred during the 1 to 5 year follow-up of the 32 patients who did not have tonsillectomy. Recurrent tonsillitis did occur in 4 of these patients and 3 of them had a past history of recurrent tonsillitis. The authors conclude that treatment of peritonsillar abscess should consist of needle aspiration, intravenous antibiotics and supportive measures. Interval tonsillectomy should be performed only when there is a history of recurrent tonsillitis or previous peritonsillar abscess.

Adolescent↗

PubMed1982

Combined treatment of advanced cancer of the laryngopharynx and cervical esophagus.

Advanced cancer of the laryngopharynx and cervical esophagus is difficult to treat because of the malnutrition produced by pain and obstruction and the problems related to reconstruction. This paper presents the initial results of a regimen used in 14 patients in which there is rapid reversal of nutritional deficiencies, radical resection, and reconstruction using the gastric pull-up technique and administration of postoperative radiotherapy. Excellent overall palliation and decreased hospitalization have been achieved using this regimen without diminishing chances for cure.

Adolescent↗

PubMed1980

Set-back tongue flap for carcinoma of the tongue base.

Carcinoma of the base of the tongue has been treated with various combinations of radiotherapy and surgery. Resection of this area poses a major problem in reconstruction because of the need for establishing normal physiologic characteristics. This article emphasizes the benefits of a lateral pharyngotomy and mandibulotomy for resection of large portions of the tongue base. We describe a tongue flap with a neurovascular pedicle that is set back into the tongue-base deficit. This one-stage procedure is relatively easy to perform and provides good physiologic results.

Aged↗

PubMed1973