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Biomedical subjects

J M Loré

Publications and source records attributed to J M Loré.

At least 19 recordsLinked to original sources
PubMed1998

Thirty-eight-year evaluation of a surgical technique to protect the external branch of the superior laryngeal nerve during thyroidectomy.

The purpose of this study is to evaluate a surgical technique for the preservation of the function of the external branch of the superior laryngeal nerve (EBSLN) during total thyroid lobectomy and total thyroidectomy. Permanent injury to this nerve can be a disaster, especially in singers and professional speakers who depend on control of pitch, and a clear and forceful voice. Voice changes may be either obvious or subtle. For better voice analysis, a detailed questionnaire is necessary. Thus, the evaluation in this study is based on laryngoscopy of 934 nerves in 675 patients and detailed subjective voice evaluation of 66 patients during the last 2 years of the study. There are 2 surgical principles. First, the EBSLN is not routinely exposed; the distal 1.5 to 2.0 cm (critical area) of the superior thyroid vessels are carefully dissected, exposed, and ligated, preferably independently. Careful observation ensures that the EBSLN is not included in the ligature. Second, the ultimate evaluation of the surgical technique is the effect of voice changes on the patient's lifestyle. Laryngoscopy of 934 nerves found bowing, temporary in 4 patients and permanent in 1 patient (limited follow-up). Of the 66 patients with voice evaluations, 14 had changes: 9 had temporary changes, while 5 had permanent changes. In these 14 patients, voice changes had no effect on lifestyle in 13, and the effects were indeterminate in 1 (unavailable for follow-up). The estimated deleterious effect of voice changes on lifestyle is no greater than 1.5% of the 66 patient responders.

Anatomy, Artistic↗
PubMed1995

Access to the superior mediastinum.

Surgical access for diseases that involve the superior mediastinum can be achieved without thoracotomy by utilizing the suprasternal approach with extension of the head and neck and transection of the interclavicular ligament, median sternotomy, resection of the medial third to one half of the clavicle, or resection of the manubrium sterni. There has been minimal morbidity and no operative or postoperative mortality in a review of 53 consecutive patients. There has been no significant disability. Combined with exposure at the base of the neck, the access to the superior mediastinum is good to excellent.

Clavicle↗
PubMed1995

Improved survival with preoperative chemotherapy followed by resection uncompromised by tumor response for advanced squamous cell carcinoma of the head and neck.

BACKGROUND: A total of 93 patients were treated with one of two preoperative chemotherapy regimens over a 15-year period. The study supports the importance of strict adherence to guidelines for ablative surgery. METHODS: A single surgeon performed the surgery and evaluated each patient prior to treatment. The extent of the planned operation was documented. RESULTS: The 5-year absolute survival of 88 patients who completed the protocol was estimated at 55%. The 40 cisplatin/5-fluorouracil-treated patients exhibited a significantly better outcome than the 48 cisplatin/bleomycin-treated patients (76% versus 43%, respectively). Comparison of a subset of 37 patients with a matched group from the standard control arm of the Head and Neck Contracts Program demonstrated a statistically significant improvement in overall survival over standard treatment. CONCLUSIONS: These data suggest that strict adherence to preoperative chemotherapy planning of ablative uncompromised surgery contribute to improved survival. Selective rather than routine postoperative radiotherapy may be advantageous.

Antibiotics, Antineoplastic↗
PubMed1991

Surgery for advanced thyroid malignancy.

Advanced thyroid malignancy can occur early in the course of the disease, or as late as 20 to 25 years after the initial diagnosis. The basic treatment is total thyroidectomy with central node dissection regardless of the histologic type. the nonresectable disease is treated with 131I if the tumor has iodine uptake. Further ablative surgery for resectable disease is governed by location and histologic cell type. Otherwise external radiation and chemotherapy (Adriamycin) is used. Anaplastic, primary squamous cell, and pure papillary and some predominantly papillary carcinomas and some Hürthle cell carcinomas do not have 131I uptake and fall into this latter category. The surgeon must be aware of this problem in the noniodine uptake tumors and take special care to remove all surgically resectable disease.

Combined Modality Therapy↗
PubMed1990

The treatment of metastatic thyroid disease.

1. Removal of all resectable disease commensurate with reasonable morbidity and mortality is the initial treatment of all thyroid carcinoma. 2. Patients with no evidence of recurrent metastatic well-differentiated thyroid carcinoma should be placed on suppressive doses of Synthroid. 3. 131I is utilized for nonresectable and for distant metastatic well-differentiated thyroid carcinoma. External radiation therapy and chemotherapy are utilized in recurrent or metastatic thyroid carcinomas that do not concentrate 131I.

Adrenal Gland Neoplasms↗
PubMed1989

Long-term follow-up of chemotherapy in advanced head and neck cancer.

We treated 94 patients with advanced head and neck cancer with a combined-modality protocol that included induction chemotherapy followed by surgery with and without radiotherapy. With a minimum follow-up of 3 1/2 years, 33 (35%) of the patients were alive and disease free. Thirty (32%) of the patients died of recurrent head and neck cancer. Complete response to chemotherapy and initial tumor bulk correlated with prolonged disease-free survival. Site of disease had no effect. There appeared to be no advantage to the use of routine postoperative radiotherapy in these advanced tumors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Preoperative adjuvant chemotherapy for advanced head and neck cancer: a surgical evaluation.

This presentation consists of two parts: 1) a brief account of the results of treating 94 patients with stage III (n = 24) and stage IV (n = 70) advanced head and neck cancer, primarily with two courses of preoperative adjuvant chemotherapy; and 2) an evaluation of 42 of the 94 patients consecutively treated by surgery by the senior author. It is our conclusion that preoperative chemotherapy using cisplatin, vincristine, and bleomycin can improve the compromised airway and deglutition without producing deleterious effects relative to surgical complications. Moreover, overall survival is promising and justifies continued study using organized protocols.

Airway Obstruction↗
PubMed1988

Use of the Kirschner wire for mandibular reconstruction.

An adaptation of the Kirschner wire, using tie wires for fixation of the Kirschner wire in primary mandibular reconstruction following ablative surgery, is described. Eighteen patients with a Kirschner wire serving as a prosthesis following mandibular resection were followed up. Except for three patients, who had extensive resection of the tongue, all patients were judged as having satisfactory mastication and deglutition. Only two patients required another operation for wire-related complications. The Kirschner wire, when modified as presented, proved a dependable and stable prosthesis for mandibular reconstruction.

Adult↗
PubMed1987

Custom cervical splint for use during head and neck surgery.

A custom-made plaster cervical/occipital splint was described that was made to immobilize a patient with vertebral metastases during neck surgery. This is a single example of a problem solved by the cooperation between the head and neck surgeon and the maxillofacial prosthodontist.

Adult↗
PubMed1986

Two modifications of pectoralis major myocutaneous flap (PMMF).

Pectoralis major myocutaneous flap is the most commonly used versatile flap in head and neck reconstructive surgery. The use of entirely tubed pectoralis major myocutaneous flap for reconstruction of the hypopharynx following total laryngectomy and total pharyngectomy has a disadvantage of bulkiness of the flap and poor postoperative deglutition. One-stage reconstruction of the entire hypopharynx utilizing a combination of pectoralis major myocutaneous flap and dermal graft minimizes bulkiness, thus achieving satisfactory to excellent functional results. The operation has been performed on four patients with excellent deglutition. The pectoralis major myocutaneous flap is utilized to reconstruct the anterior and lateral walls of the hypopharynx, the dermal graft for the posterior wall as far superior as the vault of the nasopharynx. The operative procedure is described. Pectoralis major myocutaneous flap usually provides enough length to reach the distant site of the surgical defect. On occasion, however, additional length is desirable to avoid tension along the suture line. This becomes apparent when a random portion of elevated pectoralis major myocutaneous flap presents questionable viability which may require further trimming. Resection of the medial half of the clavicle can provide additional length of this flap by 2 cm to 2.5 cm.

Aged↗
PubMed1983

Practical anatomical considerations in thyroid tumor surgery.

Of the nine practical anatomical considerations relative to thyroidectomy, the relationship of the recurrent laryngeal nerve to the posterior suspensory ligament of the thyroid rather than the nerve relationship to the inferior thyroid artery is believed to be the most important. Thus, the surgeon is admonished first to locate the nerve at or just above the superior thoracic inlet as one of the initial steps in thyroidectomy. The other more important considerations are the surgical anatomy of the external branch of the superior laryngeal nerve and the fact that often the parathyroid glands can be retrieved from the surgical specimen while still in the sterile surgical field and then can be reimplanted.

Humans↗
PubMed1982

Adjuvant chemotherapy in advanced head and neck cancer. An update.

Two courses of triple-agent chemotherapy were given to 47 patients with advanced head and neck cancer. All but one patient with a nasopharyngeal carcinoma had resectable stage III and IV squamous cell carcinoma. Eighty-eight percent of the patients responded to the chemotherapy with a 50 percent or greater decrease in tumor size. Forty-three patients underwent surgical resection and 19 were histologically upgraded to stage II or better (T less than 2 cm, N0). None of these 19 patients have relapsed, with follow-up ranging from 12 to 42 months. In 12 of the 47 patients, recurrent tumor developed within the first 18 months of follow-up.

Antineoplastic Agents↗
PubMed1982

One-stage reconstruction of the hypopharynx using myomucosal tongue flap and dermal graft.

Reconstruction of the hypopharynx following total laryngectomy and total pharyngectomy provides a one-stage procedure to reconstitute the food conduit. A myomucosal advancement tongue flap forms the anterolateral walls, and the dermal graft forms the posterior wall of the reconstruction. Sixteen patients underwent reconstruction by this method. Thirteen required total laryngectomy and total pharyngectomy for extensive carcinomas. Two other patients who had previous laryngectomy and hypopharyngeal recurrence had pharyngectomy and repair by tongue flap and dermal graft. A third patient required laryngopharyngectomy following recurrence after supraglottic laryngectomy. No postoperative deaths have occurred. Anteriolateral defects of up to 8 cm in size can be reconstructed providing the neck can be flexed. Larger posterior defects superior to the eustachian tube can be closed. In two patients minor fistulas developed which closed spontaneously. One other patient had a delayed wound dehiscence and infection with fistula and carotid blowout. The patient had undergone previous surgery and radiotherapy. Deglutition was good to excellent in most patients. Three patients required esophageal dilatation with resolution. Cinegraphic studies have demonstrated the tongue to propel a bolus and to modulate speech which shows this repair to create a dynamic conduit. One patient had difficulty in swallowing because the left hypoglossal nerve was resected. Seven patients were alive with no evidence of disease 2 to 30 months postoperatively. Four patients who were free of their original disease died from other causes. Four patients died from original disease 5 to 23 months postoperatively. At present, one patient is alive with disease. Tongue flap and dermal graft provide a reliable and one-stage reconstruction following laryngopharyngectomy and should be considered as an alternative to distant flap and intestinal interposition reconstructive procedures.

Carcinoma↗