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Biomedical subjects

M B Flynn

Publications and source records attributed to M B Flynn.

At least 37 records · Page 2Linked to original sources
PubMed1993

Active chronic peptic ulcer disease complicated by gastric outlet obstruction in pregnancy.

A case of active peptic ulcer disease in a primigravida at 29 weeks' gestation is presented, with a literature review. This particular case was complicated by gastric outlet obstruction, a complication which has not been previously reported in the obstetric literature. Although an uncommon diagnosis in pregnancy, the investigations for peptic ulcer disease should be actively pursued. Treatment can prevent serious complications.

Adult↗
PubMed1992

Squamous cell carcinoma of the upper aerodigestive tract in patients 40 years of age and younger.

Oral squamous cell carcinoma in patients 40 years of age and younger has been noted to be infrequent. The incidence is not as noticeable because the majority of oral cancers are diagnosed during the later decades of life. This study was undertaken to evaluate the incidence, site predilection, etiologic factors, and modes of treatment and to compare these results with available data on this topic. Of 1387 cases of oral and pharyngeal squamous cell carcinoma diagnosed from 1968 to 1989 at University Hospital and affiliated institutions, 28 occurred in patients under 40 years of age. When these lesions were staged according to the American Joint Committee for Cancer Staging, we found 6 stage I lesions, 3 stage II, 2 stage III, and 11 stage IV. Six lesions could not be staged from information available in the patient records. Present data corroborate the national average of 1% to 3% of cases of oral squamous cell carcinoma found within the 40 and under age group.

Adult↗
PubMed1991

Frequency and experience with carcinoma of the thyroid at a private, a Veterans Administration, and a university hospital.

We evaluated the treatment experiences with thyroid carcinoma at a private, a Veterans Administration, and a University hospital to determine the frequency, treatment, and outcome of patients with this uncommon malignant tumor. All 120 patients with thyroid carcinoma were identified through hospital tumor registries between 1953 and 1988, representing 0.3% of the total cancer registry cases during this period. Well-differentiated carcinoma of the thyroid represented 73%, medullary carcinoma 7%, poorly differentiated carcinoma 18%, and Hürthle cell carcinoma 2% of histologic varieties. Seventy-eight percent of patients were treated initially by surgery or by surgery plus postoperative irradiation. The remaining patients received other treatment. At 10 years after treatment, 90% of patients with well-differentiated carcinoma survived, while only 20% of patients with medullary and poorly differentiated carcinoma survived. Sixty percent of recurrences for all histologic types appeared within the first 12 months after treatment. Patients with well-differentiated carcinoma had sporadic recurrences over a 21-year-period. Recognition of these time intervals allows for better follow-up management.

Adenocarcinoma↗
PubMed1991

Anatomic location and variety of nonmalignant neck masses seen in surgical practice.

During a 10-year interval, 189 patients, comprised of 121 females and 68 males ranging in age from 1 to 98 years, were surgically treated for nonmalignant neck masses. Nonmalignant neck masses were located in the thyroid or submaxillary gland in 60 per cent of these patients. Thyroid adenoma, reactive cervical nodes, and mixed tumor of the submaxillary salivary glands represented the three most commonly occurring nonmalignant pathologic conditions in this series. When stratified by age and sex, thyroid abnormalities, specifically thyroid adenoma, occurred most often in females of all ages. In males, reactive nodes were usually seen before 40 years of age; thereafter, tumors of the submaxillary salivary gland predominated. Most studies of nonmalignant neck masses indicate that reactive nodes are the most common condition in patients of all ages. Thyroid conditions were seen most frequently in this group of patients. The probable explanation is a tertiary referral pattern to surgeons. Patients with nonsurgical conditions were, presumably, identified and managed earlier and not referred further, and therefore did not appear in this group of patients.

Adenoma↗
PubMed1990

Fine needle aspiration biopsy in clinical management of head and neck tumors.

Ninety-five percent (195) of 203 fine needle aspiration biopsies (FNAB) of head and neck specimens contained adequate tissues for histologic evaluation. No complications or needle tract recurrences were identified. Out of 135 patients whose surgical excision followed FNAB, 5% (7/135) of the biopsies were nondiagnostic. Correlation of cytologic and histologic findings of the remaining 128 FNAB revealed a sensitivity rate of 82% (46/56), a specificity rate of 99% (71/72), and a positive predictive of value of 98% (46/47). The diagnostic accuracy of FNAB was better with salivary gland and cervical node specimens than with thyroid, skin, and subcutaneous specimens. Fine needle aspiration biopsy may be considered as the first diagnostic step in the evaluation of the mass of the head and neck region, if the nondiagnostic aspiration rate is low and the diagnostic accuracy is high.

Adenocarcinoma↗
PubMed1990

Impact of diagnosis-related groups on the quality of postoperative care of patients with neck dissections.

Two hundred eighty patients underwent neck dissection over a 10-year period: 138 during the 5-year period before the institution of Diagnosis-Related Group (DRG) reimbursement and 142 during the 5 years after DRG regulations. A comparison of these two groups by site of tumor, stage of disease, histopathology, previous treatment, type of neck dissection, whether neck dissection was carried out alone or in combination with another procedure, presence of preexisting disease, postoperative complications, and mortality revealed no significant differences. A 35% reduction in the length of hospital stay from 16 to 10 days was identified in the post-DRG group with no detrimental effects on patient care. The variables found to have the greatest impact on length of hospital stay were the extent of operation and postoperative complications.

Diagnosis-Related Groups↗
PubMed1989

Reconstruction with free bowel autografts after pharyngoesophageal or laryngopharyngoesophageal resection.

Reliability has become a foremost requirement in pharyngoesophageal reconstruction because of the disastrous consequences after a failure. Our institution has achieved a 97 percent success rate using the free bowel autograft. We believe that this represents a significant accomplishment and designates the free bowel autograft as the reconstructive method of choice after pharyngoesophageal resection.

Aged↗
PubMed1988

Use of carbon dioxide laser for the treatment of premalignant lesions of the oral mucosa.

The carbon dioxide laser was used for the treatment of 20 lesions of the oral mucosa in 14 patients. These lesions ranged histologically from benign hyperkeratosis to verrucous carcinoma. The patients selected for this treatment were identified at high risk to develop malignant lesions in the oral cavity. Precise vaporization of the affected mucosa were carried out using the Cavitron 40-300-A CO2 Surgical Laser. Destruction of the surface epithelium and submucosa was achieved by using defocused beam at a setting of 10W. Biopsies were taken at 1 cm intervals at the time of laser treatment. Fourteen of the 20 procedures were carried out under local anesthesia on an outpatient basis. Seven procedures were performed under general anesthesia and 2 patients required 24 h postoperative observation. Local control was achieved in 17 of the 20 treated sites. Two of the three treatment failures occurred in patients in whom the final histology revealed either in situ or invasive squamous carcinoma. Only one patient with dysplasia was not controlled after vaporization of the lesion by the carbon dioxide laser. The laser continues to show encouraging results as an alternative to surgical resection of precancerous mucosal lesions of the oral cavity. Vaporization of the dysplastic lesion(s) with carbon dioxide laser is recommended for patients with an identifiable risk for the development of intraoral malignancy. This is an effective, nonmorbid, inexpensive, quick, and relatively painless method of managing this condition.

Adult↗
PubMed1987

Comparison of primary and secondary treatment in squamous oral cancer.

A popular rule of thumb has often prevailed in treating oral cancer: Try one modality first; if it fails, try the other--the chance for cure will still be good. To study this dogma, a group of 160 consecutive patients with oral cavity squamous carcinoma were reviewed. A hypothesis was formed: secondary treatment for recurrent cancer, whether surgery after radiation failure or vice versa, would salvage essentially as many patients as primary treatment, say within 15%. Results show a large difference in success rates between first and second treatments when all stages are considered together, a difference well over 15 percentage points. Regarding each stage separately, the largest difference occurs in stage II (28 percentage points); other stages exceed 15 point differences. No significant differences in successful salvage occur between "home" failures and "elsewhere" failures. Local recurrence was a major cause of failure in both groups (55%). We conclude that recurrence of oral squamous cancer after first treatment markedly reduces patients' chance for cure.

Aged↗
PubMed1987

Preoperative outpatient nutritional support of patients with squamous cancer of the upper aerodigestive tract.

In this study, 59 percent of the patients with squamous cancer of the upper aerodigestive tract were considered malnourished by the independent evaluation of a registered dietitian. Malnourished patients tended to present in a more advanced stage of disease, underwent more extensive operative procedures, had more complications, experienced longer hospital stay, and had a higher proportion of irradiated patients compared with patients who were nutritionally healthy. Malnourished patients who received nutritional support preoperatively demonstrated lower complication rates and shorter lengths of hospital stay compared with malnourished patients who underwent similar operative procedures without preoperative nutritional supplementation.

Aged↗
PubMed1986

Evaluation of size in prognosis of oral cancer.

Greatest surface diameter of a cancer, together with suspicion of regional node metastasis, forms the basis for prognosis through the clinical TNM staging system for many cancers. In oral cancer, however, surface size sometimes fails to correlate, or sometimes inversely correlates, with tumor aggressiveness. To shed light on the value of measuring size per se, 155 consecutive oral squamous cancers, treated by surgery, radiation, or a combination, were analyzed to find the degree of correlation between greatest surface measurement and pathologic nodal spread and control of cancer. In tumors less than 2 cm, size correlated with very few nodal metastases and with good prognoses; in tumors greater than 2 cm, increasing size did not show a corresponding increase in pathologic node metastasis or significantly worsening outcomes except for a few very large cancers invading adjacent structures. In conclusion, greatest surface diameter of an oral cancer, when greater than 2 cm, is an unreliable predictor of tumor behavior per se. A small pilot study suggests that tumor thickness may be a better predictor. A formal study of this is planned.

Aged↗
PubMed1985

Squamous cell carcinoma of the upper aerodigestive tract in nonusers of tobacco.

Nine hundred forty-five patients with squamous cell carcinoma of the upper aerodigestive tract (SCC-UADT) were treated at three University of Louisville-affiliated hospitals from 1970 through 1979. Retrospective analysis disclosed that 33 patients (3.4%) never used tobacco. This group offers interesting contrasts to the more prevalent tobacco-related epidermoid cancers. Cancers in nonusers of tobacco (mean age, 68 years) occurred approximately 10 years later than most epidermoid UADT cancers. Women predominated with a ratio of 2.7 to 1. Fifteen of 16 patients (94%) older than 70 years were women. Twenty-four of 33 primary lesions (72%) were in the oral cavity and two thirds of these were staged 0, I, and II (American Joint Commission [AJC]). Of the patients younger than 70 years of age, 42% were men, 42% had non-oral primaries, and most (74%) had advanced disease in AJC Stages III and IV. Second squamous cell primaries of the UADT developed in 6 of the 33 patients (18%) with an average of 48 disease-free months. Five of six were oral lesions in patients with original oral primaries. Of the 16 patients older than 70 years with small, localized oral cancers, conservative surgery failed in 9 (56%). Although 4 were salvaged by re-excision or radiation, 5 of these 16 patients in AJC Stage 0, I, and II died of this cancer (32%). The tendency for conservative initial surgical treatment in older patients is believed to be responsible for the higher than expected rate of treatment failure. An aggressive approach is recommended and further supported by the complete absence of surgical mortality in this group of patients.

Aged↗
PubMed1984

Microvascular free tissue transfer in head and neck and esophageal surgery.

Successful reconstruction for excisional defects of the head and neck and esophagus was accomplished in 93 percent of our patients using microvascular free tissue transfer. Complete failure occurred in 7 percent of the patients. Major defects after head and neck cancer surgery constituted the main indication for use of microvascular free tissue transfer for reconstruction. Ninety-four percent of the patients had undergone an extensive excisional procedure. A wide range of cutaneous, myocutaneous, and osteocutaneous free flaps, as well as free bowel autotransfers were used. Complete failure was three times higher in the previously irradiated patients (4 of 41 patients) compared with nonirradiated patients (1 of 34 patients). Morbidity and mortality rates were consistent with expected ranges in patients who were undergoing major head and neck resection. Donor site complications occurred in 23 percent. Thin flaps are favored for reconstruction of anterior defects in the oral cavity, whereas bulkier flaps are more suitable for deeper defects in the oropharynx and hypopharynx. The advantages are both aesthetic and functional. The free jejunal autograft is considered the reconstructive method of choice for defects produced by laryngopharyngoesophagectomy. Highly developed and sophisticated microsurgical skills continue to be the mainstay of success. The implication of free tissue transfer failure, especially for defects of the upper aerodigestive tract, are impressive in terms of morbidity, mortality, and cost. These considerations limit the application of this method of reconstruction to centers that have sophisticated and productive reconstructive surgeons with microsurgical skills.

Adolescent↗
PubMed1984

Irradiation of nasopharyngeal carcinoma: correlations with treatment factors and stage.

Eighty patients with nasopharyngeal carcinoma were treated with radiotherapy in the Radiation Center at the University of Louisville from January 1955 to December 1980. Among the patients were 70 whites, nine blacks and one Chinese; their ages ranged from eight to 82 years. There was a 40% recurrence rate within the nasopharynx, and a 29% recurrence rate within neck nodes. The five year survival and relapse-free survival rates of the entire group were 36 and 33%, respectively. Forty-nine patients died of cancer, four patients died of intercurrent disease and eight patients were lost to follow-up. Nineteen patients are alive and free of disease. Factors considered in this study included tumor and nodal status, the presence of cranial neuropathy, the size and area irradiated, and dose delivered. Primary site relapse was not demonstrated to be dependent on T group or nodal status, but was likely to be related to inadequacy of original treatment volume and dose. A higher survival was noted with our lymphoepithelioma category (p = .056).

Adenocarcinoma↗