Search PubMed⌕ Search

Biomedical subjects

J M Fredrickson

Publications and source records attributed to J M Fredrickson.

At least 19 recordsLinked to original sources
PubMed1995

Squamous cell carcinoma of the pyriform sinus: a nonrandomized comparison of therapeutic modalities and long-term results.

From January 1964 through December 1991, 408 patients with squamous cell carcinomas involving the pyriform sinus were treated at Washington University Medical Center. Their ages ranged from 29 to 83 years (mean, 62.3; median 59) and the male to female ratio was 5:1. The mean duration of symptoms prior to diagnosis was 3.9 months (range 1 to 32 months) and 89% had a smoking or ethanol history. Sixty-seven percent had T3 or T4 lesions and 87% were stage III or IV at presentation. Sixty-nine percent had neck metastases. The treatment strategy varied with respect to radiation and reconstruction. Prior to 1978, preoperative radiation (3.5 to 5000 cGy) was used. Postoperative radiation was given thereafter (600+ Gy). Since 1982, flap reconstruction (usually pectoralis major myocutaneous) has been used to close the partial laryngopharyngectomy (PLP) defect. Almost all N0 necks were treated by radiation or surgery and all N1-N3 lesions were treated by combined therapy. Pyriform tumors were subdivided into three groups: 1. one-wall lesions (n = 48), 2. medial-wall lesions which involved the aryepiglottic fold or supraglottis (N = 267), and 3. two- or three-wall lesions which extended to the pyriform apex or post-cricoid region (N = 93). Ninety-five patients had single-modality therapy and 302 had combined treatment. Two hundred seven patients had conservation surgery (PLP) and 157 had total laryngopharyngectomy alone or in combination with radiation. Thirty-three patients were treated by radiation alone. Eleven patients were excluded from the study because of distant metastases (TxNxM1) at presentation. The cumulative survival (NED) at 5, 10, 15, and 20 years was 56%, 35%, 31%, and 20%, respectively. The cumulative locoregional control rate was 71%. At 5 years (NED), the cure rates for one-wall lesions (73%) were better than for medial-wall lesions (63%) or 2- and 3-wall lesions (49%). One-wall lesions were smaller, medial-wall lesions behaved similar to supraglottic tumors, and two- or three-wall tumors behaved as hypopharyngeal tumors. The cure rates were related to T stage with T1 + T2 > T3 + T4 (28%). Neck metastases reduced the cure rate by 26% and N1 > N2-N3 by an additional 12%. Other factors contributing to therapeutic failure were distant metastases (17.7%), second primary tumors (6.2%; oropharynx and lung were most common), and intercurrent disease fatalities (9.5%). The secondary therapeutic salvage rate was 44% for surgery and 32% for radiation therapy. The therapeutic complication rate was 19% with 3.6% leading to fatality.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Vibratory segment function after free flap reconstruction of the pharyngoesophagus.

Reconstructive options following total laryngopharyngectomy include thin, pliable free tissue segments, approximating the natural thickness of the pharyngeal wall. The authors have investigated outcomes in the following clinical series, emphasizing speech and swallowing. Twelve cancer patients underwent laryngopharyngectomy with or without glossectomy. Eight jejunal, 1 radial forearm, and 3 innervated latissimus dorsi flaps were used for vibratory segment (VS) reconstruction, and all 12 patients underwent tracheoesophageal puncture (TEP). Eleven patients achieved intelligible speech, with a median intelligibility of 93%. The vibrating segments showed fluttering of the free flap tissue when studied by videopharyngography. Vocal quality was lower pitched and softer than "conventional" TEP speech. All patients achieved oral intake as their primary mode of nutrition. Free flaps are a successful option for VS reconstruction in patients undergoing laryngopharyngectomy or glossopharyngolaryngectomy, obviating the need for written or electrolarynx communication.

Aged↗
PubMed1995

Squamous cell carcinomas of the aryepiglottic fold: therapeutic results and long-term follow-up.

Three hundred fifteen patients with squamous cell carcinomas involving the aryepiglottic (A-E) folds were treated between January 1964 and December 1991. The age ranged from 39 to 87 years (mean, 62.4 years; median, 61.3 years) and the male-to-female ratio was 5:1 (54 women and 261 men). Symptom duration prior to diagnosis was 4.8 months. Eighty percent of patients had T3 and T4 lesions and 56.3% had neck metastases at presentation. Six patients (1.8%) had distant metastases and were excluded from this study. Clinically the tumors presented as either exophytic infiltrating lesions which were confined to the A-E fold (n = 57) or mucosally spreading tumors which extended to the lateral supraglottis or pyriform sinus (n = 258). Prior to 1978 preoperative radiation (3000 to 5000 cGy) was used. Higher doses of postoperative radiation (5000 to 6000+ cGy) were used thereafter. After 1982 the use of myocutaneous flaps for closure of partial laryngopharyngectomy defects was routine. Almost all N0 neck disease was treated by radiation or surgery. Combined therapy was used in N1-N3 disease. One quarter of the patients had single-modality therapy (25.7%; 81 patients) with a cumulative 5-year disease-free survival of 53%. The remainder of the patients (n = 234) had combined therapy with a cumulative 5-year survival of 67.2%. The latter group had 163 conservation surgeries and 121 total laryngectomy resections. The 5-year disease-free survival for preoperative radiation with surgery (68%) and postoperative radiation with surgery (64%) was similar. Those treated by radiation alone had a 34% 5-year disease-free survival and those treated with surgery alone had a 61% 5-year disease-free survival. The cumulative locoregional control rate was 77%. The cumulative disease-free survival at 5, 10, 15, and 20 years is 66%, 57%, 55%, and 55%, respectively. Infiltrating tumors had a better disease-free survival (by more than 10%) than spreading tumors. The 5-year survival rates were separated well by clinical stages of tumors. In patients with T1 tumors the 5-year survival was 87%; in those with T2 tumors, 80%; in those with T3 tumors, 78%; and in those with T4 tumors, 41%. The survival rate was greater in those with N0 tumors than in those with N+ tumors by 25% and greater in those with N1 tumors than in those with N2 + N3 tumors by an additional 18%. The overall complication rate was 26% and in 7.7% these were fatal.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Ongoing investigations into an implantable electromagnetic hearing aid for moderate to severe sensorineural hearing loss.

Over 20 million Americans have a hearing loss that produces problems in communication. The majority of these hearing-impaired individuals would benefit from conventional hearing aids, yet only about 15% use amplification devices. Many of the reasons for the lack of use of conventional hearing aids can be resolved by an implantable middle ear device directly coupled to the ossicular chain. This article presents the advantages of the implantable middle ear device.

Acoustic Stimulation↗
PubMed1991

The latissimus dorsi donor site. Current use in head and neck reconstruction.

Reconstruction of head and neck defects after trauma, tumor extirpation, or disease has improved with the modern development of multiple donor sites. However, the selection of a particular pedicled or free flap should balance the required sophistication of repair with donor site morbidity. The latissimus dorsi donor site is capable of providing a versatile group of tissues; ie, muscle, skin, subcutaneous tissue, bone, nerve, and vascular pedicle. We present a series of 30 latissimus dorsi flaps (20 pedicled and 10 free) used for craniotemporal, craniofacial, midfacial, oral, oropharyngeal, mandibular, and neck skin reconstructions. The flap survival rate was 90%, a result similar to other large series. The indications for using the latissimus dorsi as opposed to other donor sites were large skin defects, cephalad defects, total glossectomy defects, defects requiring free tissue transfer, and defects where other regional donor tissue was unavailable. We also present a novel flap design for total glossectomy reconstruction.

Adolescent↗
PubMed1990

Cervical metastases from unknown primaries: radiotherapeutic management and appearance of subsequent primaries.

Between 1964 and 1986, 72 patients who presented with squamous or undifferentiated metastatic carcinoma to neck nodes, where the primary tumor could not be found by standard clinical procedures, were treated at the Mallinckrodt Institute of Radiology. These cases were managed in the following manner: biopsy and radiotherapy in 46 out of 72 patients, radiotherapy (RT) and a planned neck dissection in 14 out of 72, and neck dissection after failure to achieve a complete response (CR) with RT in 12 out of 72. Minimum follow-up was 2 years. The initial CR rates for stages N1, N2a, N2b, N3a, and N3b were 83%, 93%, 61%, 50%, and 33%, respectively. The long-term neck tumor control for the same stages was 83%, 71%, 67%, 44%, and 50%, respectively. One patient had soft tissue necrosis and two had carotid artery ruptures, one of which left no symptomatic sequelae. Twenty-one out of 72 patients developed subsequent primary tumor. Only one of these patients survived. This incidence was not affected significantly by prophylactic treatment of the mucosal areas except in patients with bilateral neck nodes, undifferentiated or poorly differentiated histologies, and/or posterior cervical node involvement. A multivariate analysis showed that prognosticators of an improved disease-free survival were: a complete clearance of tumor by the end of radiotherapy (p less than 0.0009) and no appearance of a subsequent primary tumor (p = 0.035). The only factor that correlated with an increased loco-regional control was having a complete response by the end of radiotherapy (p less than 0.00009). The recommended management and possible ways of preventing the appearance of subsequent primaries will be discussed.

Adult↗
PubMed1988

Comparison of benefit from vibrotactile aid and cochlear implant for postlinguistically deaf adults.

Four postlinguistically deaf adults were evaluated presurgically with a one- or two-channel vibrotactile aid and postsurgically with a multichannel, multielectrode, intracochlear implant. Although the vibrotactile aid provided awareness of sound and enhanced flow of conversation, benefit to lipreading was small on videotaped tests and speech tracking. Scores on recorded, sound-only speech tests were not significantly above chance except in discrimination of noise from voice. With the cochlear implant, benefit to lipreading was significantly greater than with the vibrotactile aid, and scores on sound-only tests were significantly above chance. Communication was markedly better with the implant than with the vibrotactile aid. In counseling those who get no benefit from a hearing aid, the results of this study provide data on the amount of benefit one- or two-channel vibrotactile aids provide postlinguistically deaf adults who are subsequently implanted.

Adult↗
PubMed1984

Ventilation during laryngoscopy in chronic obstructive lung disease.

Many patients requiring direct examination of the upper airway and gastrointestinal tract under general anesthesia have chronic obstructive lung disease, yet virtually no work has been done to assess the adequacy of their ventilation during laryngoscopy and in the early postoperative period. This study demonstrates that, using the Carden tube, their blood gases are well maintained even when areas outside the endolarynx, such as the upper esophagus, are examined. The Carden tube is shown to be easy to insert and remove as well as permitting a superior view of the larynx. Also, this study pinpoints the period of maximum danger of respiratory failure as occurring postoperatively in the recovery room. This should be independent of the method of ventilation employed at surgery and indicates the need for cocainization of the vocal cords before extubation, as well as careful, early postoperative monitoring. The problems of ventilation during direct examination of the upper airway and gastrointestinal tract are discussed and alternative methods evaluated.

Adult↗
PubMed1983

The irradiated larynx and voice: a perceptual study.

The voices of patients with laryngeal cancer following a specific radiotherapy regimen were subjected to perceptual evaluation. Interval scaling of the severity of perceived dysphonia was completed for the voices of male patients sampled before and 1 year following radiation therapy and for a set of male controls. Eight listeners did this quantitative rating and also specified the predominant quality in each voice. The results indicated that the degree of dysphonia in the pretreatment group was highest. Radiotherapy decreased this dysphonia but not to the point that posttreatment voices were indistinguishable from those of normal subjects. Also, the voice qualities of laryngeal cancer patients shifted toward those of the control group following radiotherapy with over one half of the irradiated patients judged to have rough or normal qualities.

Adult↗
PubMed1981

Efferent vestibular neurons: a study employing retrograde tracer methods in the pigeon (Columba livia).

Efferent neurons innervating the vestibular labyrinth and cochlea of the pigeon have been identified by means of a variety of retrograde tracers: [3H]-adenosine (Ad), horseradish peroxidase (HRP), Evan's Blue (EB) and Bisbenzimide (Bb). Discrete injections into individual cristae ampullares of the semicircular canals, into the macula utriculi, or into several of these end organs resulted in similar patterns of neuronal labelling. Efferent vestibular neurons were always found within a small portion of the nucleus reticularis pontis caudalis (RP), ventrolateral to the abducens nucleus on both sides. No systemic difference in the locations of labelled cells was found following injection into different sensory epithelia. Cell counts following injections into individual cristae did not differ significantly from those following injections into all three cristae. The injections into all cristae in both labyrinths yielded cell counts that were much lower than twice the number of cells labelled by injections into the three cristae on one side only. When HRP was injected into the right lateral canal crista and Ad into the right posterior canal crista, a high proportion of neurons was labelled with both compounds (61% of the HRP-labelled cells and 67% of the Ad-labelled cells). Injections of EB into all three cristae on the right side and Bb into all three cristae on the left side produced a smaller percentage of doubly labelled cells (10% of the EB-labelled cells and 6% of the Bb-labelled cells). It is concluded, therefore, that there is a considerable degree of collateralization within one labyrinth. Fewer collaterals of efferent neurons are directed to both labyrinths. Since each semicircular canal represents head rotation in one direction and one plane, it is unlikely that efferents which contact several different movement sensors can provide sensory motor control that is specific for directions and planes of head movements. Control injections of these tracers into the cochlea yielded labelled cells in a different reticular structure, the nucleus reticularis paragigantocellularis lateralis (Pgc), on both sides, as well as in the RP. It is proposed that the Pgc cells represent cochlear efferents, while the RP neurons are related to the macula lagenae, an otolithic organ of balance in the pigeon.

Animals↗
PubMed1981

Gastric pull-up vs deltopectoral flap for reconstruction of the cervical esophagus.

Reconstruction of the cervical esophagus and pharynx after a total laryngopharyngectomy for patients with advanced hypopharyngeal cancer still remains a problem for surgeons. The results of two procedures, the tubed deltopectoral flap reconstruction and the gastric pull-up operation with pharyngogastric anastomosis, which are used in fulfilling postoperative deglutition requirements, were compared. There were nine patients in the gastric pull-up group and eight patients in the deltopectoral flap group. The groups were reasonably comparable with regard to age, sex, preoperative radiotherapy, and stage of tumor. Three of the patients in the gastric pull-up group were operated on for palliation alone. Average operation-to-swallow time was 12 days for the gastric pull-up groups and 90 days for the deltopectoral flap group. Reconstruction of the gullet with the stomach pull-up operations seems to be superior to the tubed deltopectoral flap. This is especially true if the operation is palliative because the patient is unlikely to survive more than one year after surgery.

Adult↗
PubMed1981

Occult intralabyrinthine schwannoma.

Report of a case of an intralabynrinthine schwannoma discovered unexpectedly during a labyrinthectomy for intractable vertigo, and description of the light and electron microscopic appearances. Although only 18 of these tumors have been previously reported, it is possible that some cases which are categorized as peripheral vertigo of unknown origin, may be due to an occult Schwannoma. All material removed during surgical procedures on the inner ear should therefore be submitted for histopathological examination.

Female↗
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↗