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Biomedical subjects

J H Ogura

Publications and source records attributed to J H Ogura.

At least 19 recordsLinked to original sources
PubMed1984

Transglottic carcinoma.

The cases of 152 patients with transglottic carcinoma were reviewed. There were 31% T2, 39% T3, and 30% T4 lesions. Twenty-six percent of patients had neck node metastases at initial presentation, and 19% with no neck dissection or radical irradiation to the neck subsequently developed neck metastases. Patients treated with voice conservation surgery +/- neck dissection +/- radiation (VCS +/- ND +/- R) had small transglottic carcinomas, whereas total laryngectomy +/- neck dissection +/- radiation (TL +/- ND +/- R) was used for patients with larger lesions. The reason for radiation alone (RA) was the patient's poor general condition or refusal of surgery. The total failure rate (primary, neck, and distant metastases) was 39%. Patients treated with TL +/- ND +/- R had fewer primary and stomal failures (12%) than those treated by VCS +/- ND +/- R (23%) and RA (33%), but ultimate failure after salvage treatment was the same (12%-13%). Sixty percent of patients treated with VCS and 67% with RA had their voices preserved. The major complication rate (overall, 16%) was highest in the group treated with VCS +/- ND +/- R. Five-year observed and adjusted survival for the entire group was 47% and 55%, respectively. The lower survival in the RA group was attributable to a high death rate from intercurrent disease. The incidence of second tumors was 14%. Unfavorable prognostic factors were older age, pretreatment tracheostomy, advanced stage and the presence of tumor in surgical specimen, and lymph nodes.

Adult↗
PubMed1984

Expansion hyoidplasty. 1983 First-Place Resident Research Award: clinical category.

An inspiratory, circumferential, passive collapse of the hypopharyngeal lumen is the mechanism of airway obstruction in some patients with "idiopathic" obstructive sleep apnea syndrome. While permanent tracheotomy has resolved the obstruction and reversed the associated cardiopulmonary sequelae, it is not without complications. The expansion hyoidplasty was conceived as an alternative. The hyoid bone is trisected just medial to each lesser cornu, then held in an expanded position by a permanent brace. The greater cornua with attached middle constrictor and hyoglossus are moved laterally, while the body of the hyoid with attached geniohyoid and genioglossus shifts the base of tongue anteriorly. The procedure is potentially reversible. Twenty dogs were studied before and after hyoid expansion, 10 for superior hypopharyngeal pressure-volume measurements and 10 for the closing-pressure study. Pressure-volume studies demonstrated a consistent expansion of the superior hypopharynx. Deglutition and laryngeal competence wee not grossly affected. Reexamination of four animals in the closing-pressure group 1 year postoperatively demonstrated stability of the hyoid expansion and no evidence of serious parahyoid tissue complications.

Animals↗
PubMed1983

Floor of mouth cancer: patient selection and treatment results.

Retrospective review of 126 primarily treated floor of mouth (FOM) cancers was done to study patient selection and to search for more optimum treatment strategies. Small surface lesions were treated by local excision (LE); small lesions invading FOM without lymph nodes were treated by radiation alone (RA), while larger lesions and those with palpable nodes were treated by preoperative irradiation and surgery (R + S). Ultimate control of the FOM cancer and nodes was achieved for 100% of the LE, 71% of the RA, and 75% of the R + S patients. The majority of primary tumor and nodal recurrences developed by 15 months and 35% of the failures were salvaged by additional treatment. Change in treatment strategies are suggested for surface lesions because of a poor rate of initial tumor control (43%), for patients treated by RA because of a high rate of complications (41%), and for patients without palpable lymph nodes who can be successfully treated by elective neck irradiation.

Brachytherapy↗
PubMed1983

Treatment of epidermoid and undifferentiated carcinomas from occult primaries presenting in cervical lymph nodes.

We treated 83 patients with epidermoid or undifferentiated carcinoma in cervical neck nodes without an obvious primary at our institution between 1964 and 1979. All patients received radiotherapy and 29 patients had radical neck dissection (RND) or total excisional biopsy (TEB) as well. Actuarial survival was 38% at 5 years for the entire group and 25% at 10 years. Fifty-four patients with neck control had significantly better survival (p = .0001) at 5 and 10 years than those whose neck was uncontrolled. Factors associated with improved neck control were initial size of the neck mass and the addition of surgery (RND or TEB). Analysis of failures showed that 50% of patients failed only in the primary or neck and 50% developed distant metastases. Tumor was the major cause of death. We recommend more aggressive treatment with both XRT and neck dissection in patients with large resectable neck masses to prevent regrowth of tumor in the neck.

Actuarial Analysis↗
PubMed1983

Comparative cost analysis of hemilaryngectomy and irradiation for early glottic carcinoma.

The cost of hemilaryngectomy (15 patients) was compared to that of radiation treatment (18 patients) in epidermoid carcinoma confined to the true vocal cord with normal mobility (T1N0). An average of $3,495 was saved if radiation therapy was chosen; savings in terms of working hours were also substantial. We maintain that, if different treatment methods yield the same cure rate and quality of life, then cost should be the next strong consideration in choosing a particular treatment method.

Carcinoma, Squamous Cell↗
PubMed1983

Barium examination of the pharynx after vertical hemilaryngectomy.

Vertical hemilaryngectomy (VHL) is an effective treatment for localized true-vocal-cord carcinoma. Single- and double-contrast barium pharyngoesophagrams in 13 post-VHL patients (11 with dysphagia or suspected tumor recurrence, and two asymptomatic volunteers) were reviewed retrospectively. The two asymptomatic volunteers illustrated the normal postoperative appearance, demonstrating an unaltered pharynx, with no barium aspiration. Barium aspiration into the laryngeal vestibule or trachea was seen in 10 cases and was the only abnormal radiographic finding in four such patients. Three instances of tumor recurrence were identified. In two such cases, aspirated barium revealed a narrowed, irregular lumen of the residual laryngeal vestibule with a mass protruding into the subglottic part of the airway. The third example of recurrent malignancy was manifested by a tracheoesophageal fistula. Findings on the barium examination mimicked recurrent tumor in four cases. In one instance, a mound of granulation tissue protruding into the subglottic airway was confused with tumor recurrence. In three cases, the radiographs demonstrated apparent narrowing and mucosal irregularity of the residual laryngeal vestibule. This appearance was due to early postoperative edema or to transient deformity of the pliable residual hemilarynx during deglutition, as shown by videotaped fluoroscopy.

Barium↗
PubMed1983

Expansion hyoidplasty: a potential surgical procedure designed for selected patients with obstructive sleep apnea syndrome. Experimental canine results.

Some patients with "idiopathic" obstructive sleep apnea syndrome have an inspiratory, circumferential, passive collapse of the hypopharyngeal lumen as the mechanism of airway obstruction. Permanent tracheotomy has offered documented dramatic resolution of the airway obstruction with reversal of the associated cardiopulmonary sequelae. Tracheotomy is not, however, without psychological and physical complications detracting from its use. In hope of developing a surgical alternative, the expansion hyoidplasty was conceived. The hyoid bone is transected just medial to each lesser cornu. The trisected hyoid bone is then held in an expanded position by a permanent stainless steel brace. The greater cornua with attached middle constrictor and hyoglossus are moved laterally, while the body of the hyoid with attached geniohyoid and genioglossus shift the base of tongue anteriorly. The procedure is potentially reversible. Twenty dogs were studied pre and posthyoid expansion. Superior hypopharyngeal pressure-volume and closing pressures were obtained on 10 dogs. The pressure-volume studies demonstrate a consistent expansion of the superior hypopharynx. The average drop in pressure varied from 2.9 to 12.4 cm H2O in different animals. All posthyoid expansion dogs showed an average increase in closing pressure ranging from -4.4 to -28.3 cm H2O. Deglutition and laryngeal competence were not grossly effected. These results support the continued experimentation towards implementation of the expansion hyoidplasty in humans.

Animals↗
PubMed1982

Barium examination of the esophagus after total laryngectomy.

Barium examination of the esophagus is often useful for evaluating the cause of dysphagia, a frequent condition in patients who have undergone total laryngectomy. The examination may be difficult to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor, or the operation itself. Radiographic and clinical information on 45 total-laryngectomy patients, whose follow-up periods ranged from six months to 17 years, were analyzed. A recurrent tumor was found in 15 patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in 14 patients appeared either as a long symmetrical narrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 13 patients and presaged the development of recurrent tumors in five. Cricopharyngeal muscular dysfunction accounted for dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium examination of the esophagus, and the radiographic findings often indicate the correct diagnosis with a high degree of confidence.

Adult↗
PubMed1981

Maxillary sinus carcinoma.

Primary site control, anatomical site of failure, survival, and complications of treatment were determined in a retrospective review of primary maxillary sinus carcinoma. Sixty-one patients were treated by radiation followed by surgery and 35 by radiation alone. Primary tumor control was achieved in 69% of patients receiving combined treatment, 14% of patients treated with radiation alone, and 49% of all patients. Neck nodes were the initial site of tumor recurrence in 20% of patients treated with combined treatment. distant metastases were the first site of tumor recurrence in 8% of patients. Local control did not differ with histological type. Virtually all epidermoid and undifferentiated carcinoma recurrences occurred within 2 years, but 27% of adenocarcinomas recurred after 2 years.

Female↗
PubMed1981

Panel discussion: the management of advanced laryngotracheal stenosis. Use of the hyoid graft for treatment of laryngotracheal stenosis.

The most common cause of laryngotracheal stenosis is trauma. The stenotic area may involve the larynx, subglottis, or trachea. A hyoid bone graft has been used in 22 cases for reconstruction of the stenotic area. The hyoid graft may be used with other concomitant laryngeal procedures. A vascularized sternohyoid--hyoid graft has been used in somes cases. Of the 22 cases all but 3 have been successful. The advantages of the hyoid graft are: 1. Firm graft to maintain the architecture of the lumen. 2. Accessibility in the same operating field. 3. Patient's own graft material decreases immune rejection possibility. 4. The vascularized pedicle graft decreases possibility of hyoid resorption.

Adolescent↗
PubMed1981

Posterior packs and the nasopulmonary reflex.

Increased mortality and arterial hypoxemia have long been associated with posterior nasal packs placed for control of severe epistaxis. Several authors have postulated a nasopulmonary reflex to partially explain this clinically observed phenomenon. In ten young, healthy subjects, using a multiparameter pulmonary evaluation, posterior nasal packs were placed and no significant changes were observed in lung volumes, flow and alveolar gas exchange, especially oxygenation. These findings suggest that aspiration, sedation, and degeneration of pulmonary function with age, not a nasopulmonary reflex, have not been adequately emphasized in previously performed studies.

Adult↗
PubMed1981

Carcinoma of the oral tongue: a study of patient selection and treatment results.

Retrospective review of 118 primarily treated cancers of the oral tongue was done to study patient selection and to search for improved treatment strategies. Small surface lesions were treated by local excision (LE); most small lesions invading muscle of the tongue without lymph node metastases were treated by radiation alone (RA) while larger lesions and those with palpable nodes were treated by preoperative radiation and surgery (R + S). Ultimate control of the primary tumor and lymph nodes after initial treatment and surgical salvage was high for the lesions by LE (91%), the T1N0 lesions treated by RA (88%) and for the TxN+ lesions treated by R + S (57%). Improved treatment strategies are suggested for T2N0 lesions treated by RA because of poor tumor control (53%) and a high rate of radiation complications (25%), and for T3N0 lesions because so many of these patients died from causes other than cancer within two years. Second primary cancers were most common in those patients with a good prognosis.

Aged↗
PubMed1980

Carcinoma of the pyriform sinus: predictors of TNM relapse and survival.

To determine predictors of TNM relapse and survival for 108 patients with epidermoid carcinoma of the pyriform sinus, the histopathologic features of tumor-related and host-related characteristics were correlated with primary and/or cervical nodal failure, distant metastases, and actuarial three-year survival. Patients in this study received preoperative irradiation and partial laryngopharyngectomy (PLP) or total laryngopharyngectomy (TLP) with en bloc radical neck dissection. Higher rates of local failure were observed in patients with keratinizing tumors (34 vs. 15%), with tumors having an "infiltrating" tumor-stromal interface (30 vs. 14%), with positive surgical margins in PLP or TLP specimens (30 vs. 16%), and with extranodal extension of tumor (39 vs. 22%). The development of distant metastases was significantly correlated with nonkeratinizing carcinomas (30 vs 11%, P = 0.02), and was observed more often in patients with positive lymph nodes (17 vs. 7%). Patients with negative surgical margins in PLP or TLP excision (50 vs. 21%, P = 0.01) survived significantly longer.

Adult↗
PubMed1980

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.

Aged↗
PubMed1980

Results of conservation surgery for cancers of the supraglottis and pyriform sinus.

A retrospective review of patients treated by surgery and/or radiation for carcinoma of the supraglottic larynx and the pyriform sinus was accomplished for the period 1964-1974. This patient population reflects the 10-year period following earlier experience with conservation surgery at this institution, and, thus, updates the current status of treatment for these cancers. Endpoints examined included survival, control, pattern of failure, the influence of nodal metastasis, and voice preservation. Of 160 patients treated for supraglottic laryngeal carcinoma, 119 received conservation surgery (subtotal supraglottic laryngectomy, SSL, or partial laryngopharyngectomy, PLP); 21 patients received total laryngectomy; and 20 others received palliative radiation. The 3-year actuarial survivals for these groups were 67%, 43% and 30%, respectively. Voice was preserved in 85% of the patients treated by conservation surgery, in 70% of those treated by radiation alone, and, of course, in none of the patients receiving total laryngectomy. There were 175 patients treated for carcinoma of the pyriform sinus; 85 received PLP; 57, total laryngopharyngectomy (TLP); and 33, palliative radiation. Acturial 3-year survival was 59% for the PLP-treated group, 36% for the TLP-treated group and 11% for the palliation group. Voice was preserved in 52% of the patients treated by conservation surgery, in 6% of those treated by radiation alone, and in none of those patients treated by total laryngectomy. Comparison of this data with that in other published reports indicates that, for selected patients, conservation surgery is as effective in controlling disease as is radical surgery. Furthermore, it is possible to preserve speaking ability in a significant number of patients having carcinoma of the supraglottic larynx or pyriform sinus.

Carcinoma, Squamous Cell↗
PubMed1980

Hemilaryngectomy for verrucous carcinoma of the glottis.

Seven patients with verrucous carcinoma of the glottis treated by hemilaryngectomy are analyzed. The diagnostic criteria for this tumor are reviewed. Close cooperation between the clinician and pathologist is necessary for the correct diagnosis. The controversy regarding radiation therapy is discussed. Hemilaryngectomy is concluded to be a successful surgical modality for limited verrucous carcinoma of the larynx.

Adult↗