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Biomedical subjects

J L Freeman

Publications and source records attributed to J L Freeman.

At least 19 recordsLinked to original sources
PubMed1994

The through-and-through oromandibular defect: rationale for aggressive reconstruction.

Through-and-through oral cancer (T4+) involving contiguous mucosa, mandible, and skin is a devastating disease with poor prognosis and represents one of the most difficult reconstructive challenges in head and neck surgery. Thirty-eight patients underwent immediate microvascular reconstruction following surgical tumor ablation. The purpose of the present review was to assess the value of microvascular reconstruction in these essentially palliative reconstructive efforts. The iliac crest osteocutaneous flap was used in the majority of patients and was found to be ideal for the reconstruction of large bony and soft-tissue defects present in this group of patients. Other methods, including pectoralis major, forehead, and latissimus dorsi flaps, also were used in the soft-tissue reconstruction. The mean follow-up was 16 +/- 2 months, and the mean hospitalization was 43 +/- 22 days. The majority of patients succumbed to recurrent or related diseases, yet a few went on to survival despite the initial advanced stage of disease. A number of complications were observed. However, most patients developed normal or easily intelligible speech (65 percent), and most (78 percent) had their tracheostomies closed and sustained themselves on an oral soft diet (84 percent). Bony union was noted in the majority of patients (73 percent). Although the prognosis in full-thickness oral carcinoma is grim, it appears that palliative surgery in these cases is well justified. The goals are to shorten the duration of hospitalization, reduce morbidity, and improve the remaining quality of life. Microvascular tissue transfer offers a means to achieve these goals in a single, reliable procedure. We feel that immediate one-stage bone and soft-tissue reconstruction restores dignity and relieves suffering in this unfortunate group of individuals.

Adult↗
PubMed1992

Diagnosis of nasopharyngeal carcinoma by DNA amplification of tissue obtained by fine-needle aspiration.

BACKGROUND: In nasopharyngeal carcinoma the primary lesion is often difficult to find. Metastatic lesions occur frequently but are difficult to distinguish from other head and neck tumors. The viral genome of the Epstein-Barr virus (EBV) can be identified in the cells of this carcinoma. METHODS: We used the polymerase chain reaction (PCR) to test for the presence of EBV genomes in 15 samples of metastatic squamous-cell carcinoma of the neck obtained by fine-needle aspiration and in 26 samples obtained by biopsy of lymph nodes. For controls we used disease-free lymph nodes from 10 patients with various head and neck tumors, tonsillar tissue from 46 subjects, blood from 59 EBV-seropositive blood donors, and mononuclear cells from 8 patients with fatal lymphoproliferative lesions. RESULTS: Of the 41 malignant lesions examined, only the nine nasopharyngeal carcinomas (one primary lesion and eight metastases) contained EBV genomes. None of the 20 nodes with other types of cancer, the 10 disease-free nodes, or any of the 105 normal control samples contained detectable EBV. In two patients with suspected metastases from occult primary tumors, the presence of EBV was predictive of nasopharyngeal carcinoma; in both cases overt nasopharyngeal carcinoma developed within one year. CONCLUSIONS: In patients with suspected nasopharyngeal carcinoma, fine-needle aspiration can provide tissue for diagnosis by DNA amplification of EBV genomes. The presence of EBV in metastases from an occult primary tumor is predictive of the development of overt nasopharyngeal carcinoma.

Base Sequence↗
PubMed1992

Detection of occult nasopharyngeal primary tumours by means of in situ hybridization.

Detection of nasopharyngeal carcinoma primaries in patients presenting with neck node metastases may sometimes demand considerable efforts. By using the 'in situ hybridization' technique, we manage to identify the Epstein-Barr virus in neck metastases secondary to nasopharyngeal carcinomas. We propose that such identification in neck node metastases where the primary lesion is unknown indicates a nasopharyngeal primary.

DNA, Viral↗
PubMed1992

Ethmoidectomy decompression for the treatment of Graves' optic neuropathy.

When orbital decompression becomes necessary in Graves' optic neuropathy, medial wall decompression is a necessary component of the decompression procedure. The ethmoidectomy approach allows more direct visualization of the posterior ethmoids and sphenoids to effect maximum decompression. This is particularly important in cases in which computed tomography shows the medial rectus muscle to be enlarged posteriorly in the orbit. The procedure provides excellent visualization of the medial rectus. As with any medial wall decompression procedure, postoperative restriction of horizontal motility is a frequent complication, often necessitating more than one subsequent operation. The authors describe their experience with the procedure in 25 patients with Graves' optic neuropathy.

Adult↗
PubMed1992

Pleomorphic adenoma: a preliminary histopathologic comparison between tumors occurring in the deep and superficial lobes of the parotid gland.

Twenty-four cases of pleomorphic adenoma of the parotid gland were retrospectively reviewed. The histopathological features of capsular thickness, penetration and completeness, tumoral cell population and mitotic activity were analyzed in twelve superficial lobe and twelve deep lobe tumors. The capsules were found to be significantly thicker and less likely to be penetrated by tumor in the deep lobe group. No significant differences in completeness of encapsulation, cell population or mitotic activity were found between the two groups. This may explain the clinical suggestion that the less aggressive surgical approach which is often performed does not compromise the prognosis for recurrence in the deep lobe lesions.

Adenoma↗
PubMed1992

AIDS-related Kaposi's sarcoma of the sphenoid sinus.

The head and neck region is frequently involved by AIDS-related Kaposi's sarcoma, the oral cavity being the most common site of occurrence. We report on the first case of AIDS-related Kaposi's sarcoma involving the sphenoid sinus where radionuclide bone scanning and MRI were effective in suggesting the diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Use of free auricular composite graft in nasal alar/vestibular reconstruction.

Reconstruction of the nasal alar/vestibular complex following trauma or surgery presents a challenging problem. Options include bone, cartilage, and composite grafts as well as prosthetic materials. We present a case in which resection of an intranasal leiomyosarcoma, leaving a dome defect, was successfully reconstructed with an auricular composite graft.

Ear Cartilage↗
PubMed1992

Orbital hemorrhage during dacryocystorhinostomy.

Orbital hemorrhage during dacryocystorhinostomy (DCR) is a very rare but potentially devastating complication of this procedure. It is probably due to trauma to the anterior ethmoidal artery, which has a variable course and may have branches close to or in the surgical site. Increasing resistance to retropulsion of the globe is an important sign of orbital hemorrhage. If the hemorrhage does not resolve spontaneously, direct decompression of the blood within the orbit is necessary. The authors review their experience with this complication of DCR.

Dacryocystorhinostomy↗
PubMed1991

Clinical and imaging features of rhabdoid tumor of the kidney.

Rhabdoid tumor of the kidney (RTK) is a rare, highly malignant neoplasm of childhood. The clinical profile of this neoplasm differs from that of Wilms' tumor. We present two cases of RTK. In both our cases, large bulky masses with poorly defined margins and calcifications were demonstrated. The clinical and imaging findings are compared with other childhood renal neoplasms.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

The use of tissue expansion in nasal reconstruction.

The reconstruction of subtotal and total losses of the nose involves the use of local and regional flaps from a variety of areas. The forehead flap, using either a Converse reconstruction or a midline glabellar reconstruction, has been widely used for large losses. In order to obviate this type of reconstruction, we have used tissue expansion to gain large flaps for large defects. Our technique and three representative cases are presented.

Aged↗
PubMed1990

A study of cell membrane structure.

Neoplastic transformation has been associated with a variety of structural changes, among which are changes in membrane carbohydrates. Not much is known, though, e.g., how early in the tumourogenic event these changes take place and what effect these changes have on cell growth, invasion, and ability to metastasize. We were able to identify the B-D-Gal(1-3)DGal-NAc as a membrane carbohydrate component present in malignant laryngeal tissue, but not on adjacent normal mucous membrane. This carbohydrate structure was found to be present in metastatic as well as in nonmetastatic tumours. It was also found in well-differentiated as well as poorly differentiated carcinomas. We suggest that changes in carbohydrate components on the cell membrane of the laryngeal cancer cell are an early event in tumour progression and probably are not related to the degree of invasion or the ability to metastasize.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1990

Flow cytometric analysis of DNA content in laryngeal cancer.

DNA content was measured by flow-cytometric analysis in 30 paraffin embedded sections from patients with laryngeal squamous cell carcinoma. The morphological characteristics and N staging of the tumours as registered in their clinical charts were correlated with their DNA content. Eighty per cent of the tumours were found to have a predominantly aneuploid distribution of DNA values. There was no correlation between the N stage of the tumour or degree of cell differentiation and DNA content. A multiploid pattern correlates with non-metastatic laryngeal tumours and we suggest that this pattern may be a good indicator for biological activity.

Aneuploidy↗
PubMed1990

Aggressive osteoblastoma of the temporal bone: a case report.

Osteoblastoma is a rare tumor of bone which is usually present in the long bones and vertebrae. Occasionally, they present in the head and neck, and only very rarely will they have a locally aggressive clinical course. We report a case of the aggressive subtype of benign osteoblastoma and its histologic and radiologic presentation.

Adult↗
PubMed1990

MRI and neck metastases: a clinical, radiological, pathological correlative study.

In a previous report CT was shown to have no advantage over physical examination in the detection of metastatic neck disease. Therefore, a study was undertaken to evaluate whether MRI would show superiority to the CT in the diagnosis of neck nodes. A series of 35 patients with various head and neck tumors were evaluated clinically, radiographically and pathologically. Eight patients were excluded from the study because of various problems involving the MRI. Therefore, 27 patients with 30 neck dissections were analyzed. There was little advantage of MRI over clinical examination in the detection of metastatic neck disease. The present size criterion for the diagnosis of occult malignant nodes is not reliable. The soft tissue contrast resolution reported by MRI is inadequate to detect minimal morphological changes in lymph nodes involved by metastases, and MRI is difficult in patients who have airway or foodway obstruction.

Head and Neck Neoplasms↗
PubMed1989

Hospital use and mortality among Medicare beneficiaries in Boston and New Haven.

We compared rates of hospital use and mortality in fiscal year 1985 among Medicare enrollees in Boston and New Haven, Connecticut. Adjusted rates of discharge, readmission, length of stay, and reimbursement were 47, 29, 15, and 79 percent higher, respectively, in Boston; 40 percent of Boston's deaths occurred in hospitals as compared with 32 percent of New Haven's. High-variation medical conditions (those for which there is little consensus about the need for hospitalization) accounted for most of these differences. By contrast, discharge rates for low-variation medical conditions (which tend to reflect the incidence of disease) were similar. Inpatient case-fatality rates were lower in Boston than in New Haven (RR = 0.85; 95 percent confidence interval, 0.78 to 0.92), but when all deaths (regardless of place of death) were measured, the mortality rates in Boston and New Haven were nearly identical (RR = 0.99; 95 percent confidence interval, 0.93 to 1.05). We conclude that the lower rate of hospital use by Medicare enrollees in New Haven was not associated with a higher overall mortality rate. Population-based as well as hospital-based statistics are needed to evaluate differences in hospital mortality rates for high-variation medical conditions.

Aged↗
PubMed1989

Variations in rates of hospitalization of children in three urban communities.

Hospitalization accounts for a large portion of the expenditures for child health care, and differences in the rate of hospitalization may produce important variations in the cost of that care. We studied the rates of hospitalization in Boston, Rochester (N.Y.), and New Haven (Conn.) in 1982. We assigned the risk of hospitalization in Rochester a score of 1.00. Boston children were hospitalized at more than twice the rate of Rochester children for most medical diagnostic categories (relative risk, 2.65; 95 percent confidence interval, 2.53 to 2.78), and the rate for the New Haven group was intermediate (relative risk, 1.80; 95 percent confidence interval, 1.68 to 1.93). Rates of inpatient surgery differed less (Boston relative risk, 1.12; New Haven relative risk, 0.93). The relative risks of hospitalization (as compared with Rochester children) for Boston and New Haven children, respectively, were 3.8 and 2.3 for asthma, 6.1 and 2.9 for toxic ingestions, and 2.6 and 2.7 for head injuries. Fractures of the femur, appendicitis, and bacterial meningitis (conditions uniformly treated in the hospital) had similar rates of hospitalization across the three cities, but the relative risk of hospitalization for aseptic meningitis was 3.7 in Boston. The rates of hospitalization of children in all three communities were below the national averages in 1982. Although this study does not define the reasons for the variation in rates of hospitalization, it is possible that they were related in part to differences in socioeconomic status or access to primary care. The implications of these data for the cost and quality of pediatric care therefore remain to be determined.

Adolescent↗