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Biomedical subjects

M S Strong

Publications and source records attributed to M S Strong.

At least 37 records · Page 2Linked to original sources
PubMed1983

Surgical lasers and soft tissue interactions.

The different physical and biological qualities of the carbon dioxide, argon, and neodymium-YAG lasers provide the otolaryngologist and head and neck surgeon with a surgical tool with specific qualities and applications. The specific wave lengths of laser energy produce a varied soft tissue action. The carbon dioxide laser energy is absorbed by all biological tissues, whereas argon laser energy is an effective photocoagulator and penetrates into the subepithelial plane; the Nd-YAG laser creates a coagulation effect, which penetrates deep into the tissues. Each laser has specific physical qualities. The argon laser and the Nd-YAG laser can be transmitted through a flexible fiberoptic delivery system, whereas the carbon dioxide laser currently requires a rigid optical delivery system. The Nd-YAG and carbon dioxide lasers both require a second coincident aiming beam because of the invisibility of their laser energy, whereas the argon laser does not have such a requirement. The spot size of the laser beam can be much smaller for the argon laser than for the carbon dioxide laser. Protective lenses are necessary for the argon, carbon dioxide, and Nd-YAG lasers. The carbon dioxide laser energy is not transmitted through glass; thus most media (glass, plastic) are suitable to prevent any ocular injury. The argon laser requires a special yellowish protective mechanism, and the Nd-YAG laser requires a green protective lens mechanism. With further technical advances and improvements in the fiberoptic delivery system, smaller laser spot sizes, and changes in operating laser modes and color specifications of lasers, the advantages of laser surgery over conventional surgical techniques will become increasingly more apparent.

Aluminum↗
PubMed1983

Laser bronchoscopic surgery.

Endoscopic laser bronchoscopy can be used to effectively palliate patients with compromised airways. The CO2 laser was utilized with a ventilating bronchoscope. This form of endoscopic surgery has the advantage of less postoperative edema, better hemostasis, more accurate tumor vaporization, and shortened operating time. Between 1975-79 33 laser bronchoscopies were carried out for airway obstruction. Palliation was achieved in most cases. Complications included intra-operative bleeding, tissue fragment occlusion of the airway, and an endotracheal fire. Laser bronchoscopy should be avoided in the presence of widespread metastatic disease, poorly differentiated or rapidly growing tumors, extrinsic tumor compression, or highly vascular tumors. A preliminary report is presented on the soft tissue effects of the argon laser, passed through a flexible coaxial cable in the canine trachea. Multiple transmural lesions were created. The use of the argon laser in the field of bronchoscopy remains controversial.

Adult↗
PubMed1982

Role of endocrine function tests in the evaluation of transsphenoidal hypophysectomy for advanced breast cancer.

Forty-three women underwent transsphenoidal hypophysectomy for metastatic breast cancer. Endocrine tests (luteinizing hormone, follicle-stimulating hormone, thyrotropin, prolactin and growth hormone) were done in 28 patients to evaluate the completeness of the procedure. Response of the metastatic breast cancer and duration of survival after hypophysectomy were determined and statistically compared with the posthypophysectomy hormone levels. Only one patient had an endocrinologically complete hypophysectomy, but the objective remission rate (32 percent) is comparable to the 30 to 40 percent objective remission rate reported in other studies that claim to have achieved complete hypophysectomy. No statistically significant associations were found between the levels of the hormones measured and the type of response (objective, subjective or none) to hypophysectomy. However, objective responders survived longer than nonresponders (p = 0.01). When analyzing the associations of the various hormone levels with the duration of survival after hypophysectomy, a positive correlation (p less than 0.05) of peak thyrotropin levels with duration of survival was found. Our data indicate that the clinical benefit advanced breast cancer patients received from an endocrinologically incomplete hypophysectomy is probably as great as that received from an endocrinologically complete hypophysectomy. It appears that a nonspecific disturbance of the hormonal milieu may adversely affect the growth of breast cancer. More studies are needed to elucidate the nature of the endocrine disturbance produced by hypophysectomy and its effects on hormone-sensitive tumors.

Adult↗
PubMed1982

Premalignant changes in normal appearing epithelium in patients with squamous cell carcinoma of the upper aerodigestive tract.

Biopsy specimens of "normal" mucous membrane of patients susceptible to the effects of the carcinogens of tobacco revealed morphologic abnormalities on electron microscopic examination that were consistent with the concept that carcinogenesis is a multistep process of sequential neoplastic development extending over a long period of time. Such changes in the upper aerodigestive tract are probably tobacco induced and may be reversible if tobacco exposure is eliminated. Use of the electron microscope can provide the clinician with an accurate assay of the severity of mucosal alterations induced by tobacco. The ability to detect such morphologic abnormalities should provide another deterrant to smoking and a useful tool in the further study of these phenomena.

Adult↗
PubMed1982

The anatomy and complications of "T" versus vertical closure of the hypopharynx after laryngectomy.

The early postoperative hypopharyngeal anatomy of 37 consecutive patients undergoing total laryngectomy at the Boston Veteran's Administration Hospital between July 1977 and April 1980 was studied by barium swallow radiographs and correlated with the technique of closure. The "pseudoepiglottis," a structure radiographically resembling a normal epiglottis, was seen arising from the anterior hypopharynx near the base of the tongue in 21 of 28 evaluable patients. It occurred in all patients with vertical closures vs. 67% of patients with a "T" shaped closure. The average length in the "T" closure group was 9.6 mm (range 0-35) vs. 18.4 mm (6-40) in the vertical group, a statistically significant difference (p less than 0.05). Radiologic strictures occurred in 39% of all patients, dysphagia in 29%, fistulae in 18%, and sinus tracts in 14%. All complications occurred more frequently in the vertical closure group. Patients who received preoperative cis-platinum bleomycin chemotherapy and postoperative irradiation had 50% dysphagia and 67% stricture rates. The average ratio of the width of the retropharyngeal space to that of C4 was 0.48 in stricture patients vs. 0.29 in non-stricture patients (statistically significant at the p less than 0.01 level). This ratio taken in the early postoperative period may help predict which patients will develop strictures.

Bleomycin↗
PubMed1982

Rhinologic surgery with the carbon dioxide laser.

Microscopic nasal surgery with the CO2 laser is easily performed. It offers the advantages of excellent hemostasis (even with coagulopathies), excellent healing, minimal discomfort and minimal complications. A wide variety of lesions may be excised, obliterated, or corrected in any age group. We report our experiences with 26 cases of rhinologic surgery with the CO2 laser. These cases represent a variety of pathologic lelsions including telangiectasias, papillomas, nasal polyps, synechiae and granulomas, rhinophymas, sebaceous adenomas, and an adenocarcinoma. This is the first comprehensive report of the use of this technique in nasal surgery.

Adult↗
PubMed1982

A comparison of combined modalities and single modality in the management of advanced head and neck tumors.

Advanced head and neck cancer patients can be managed by single modality or combined modalities. Between 1976 and 1979, three treatment groups were retrospectively identified. One group received induction chemotherapy, surgery, and postoperative radiation therapy. The second group received chemotherapy followed by radiotherapy. The third group was treated during the same time period with radiation alone. These groups were matched with respect to age, site of primary tumor, nodal status, absence of metastatic disease, and no prior cancer treatment. The combined modality groups were initially treated with two doses of cis-platinum and a bleomycin infusion. Evaluation of tumor response was done 2 weeks following chemotherapy; 24 patients had surgery and postoperative radiation, 23 had radiotherapy without surgery and 24 patients were treated with radiotherapy alone. Median survival was 22 and 13 months respectively for the 2 combined modality groups and 4.7 months for the radiotherapy group. Disease-free survival was a projected value of 40 and 35 months for the combined modality groups and an actual 3 months for the radiotherapy group. Combined modality treatment with chemotherapy and surgery and/or radiotherapy offers a higher response rate and prolonged survival than radiotherapy alone.

Bleomycin↗
PubMed1981

A sliding chest wall flap for the management of advanced laryngeal carcinoma with anterior cervical skin invasion.

A reliable sliding chest wall flap, allowing extensive resection of tumors invading the anterior cervical skin is described. There has been no instance of failure or significant complication in the use of this flap in this small series of cases presented. It is believed that its use has allowed more extensive resection of tumor without any increase in morbidity, and may account for the prolonged survival seen in four out of six patients.

Epiglottis↗
PubMed1980

Removal of rhinophyma with the carbon dioxide laser: a preliminary report.

Surgery is the generally accepted treatment for rhinophyma. Problems associated with standard therapy include moderately profuse hemorrhage impairing accurate removal, and some difficulty in providing smooth demarcation between the rhinophyma and the surrounding tissue. Four patients with rhinophyma have been successfully treated with the carbon dioxide laser. Satisfactory cosmetic results were achieved in all cases with excellent hemostasis and minimal morbidity. Complete healing takes three to four weeks, which is similar to conventional methods.

Aged↗
PubMed1980

Prognostic indicators in chemotherapy for head and neck carcinoma: alkaline phosphatase levels.

Serum alkaline phosphatase (AP), total bilirubin, total protein, serum albumin, and serum glutamic oxaloacetic transaminase (SGOT) were determined in 55 patients with biopsy proven carcinoma of the head and neck prior to their induction chemotherapy with cis-platinum and bleomycin. Of the 55 patients, 40 (73%) exhibited either a complete or partial response (tumor mass decreased by over 50%) to the chemotherapy. Responses were noted more frequently in patients with elevated AP levels. Nine of the 10 patients (90%) with AP levels greater than 100 mU/ml experienced a major response; whereas, only 8 of 16 patients (50%) with AP levels less than 60 mU/ml demonstrated a favorable response to the chemotherapeutic agents. The source of the elevated AP levels has not yet been established. Possible sources include liver, bone, kidney, intestinal mucosa, or the tumor itself. Total bilirubin, total protein, serum albumin, and SGOT levels did not differentiate the responders from the non-responders as accurately as did the AP levels.

Alkaline Phosphatase↗
PubMed1980

Prognostic indicators in induction cis-platinum bleomycin chemotherapy for advanced head and neck cancer.

A complete response to induction cis-platinum bleomycin chemotherapy significantly increases the probability of local tumor control and overall disease-free survival. Factors that favor a good response to chemotherapy are tumor histology (well differentiated), location of the primary site (oral cavity and oropharynx), nodal status (N0) and size of the primary lesion (t3 better than T4). Increased cellular maturation after chemotherapy correlates with an improved clinical response. The importance of induction and maintenance chemotherapy in the treatment of advanced head and neck cancer still needs to be determined with larger randomized series. Reliable predictors of therapy outcome are needed for realistic treatment planning, especially when the potential morbidity is considered.

Bleomycin↗
PubMed1980

Modern technology in cancer therapy: status of the carbon dioxide laser.

The carbon dioxide laser has been found to be a useful surgical adjuvant in our efforts to treat carcinoma and benign tumors of the head and neck. It has been of help in establishing the proper staging, in diagnosing recurrence after radiation therapy, in re-establishing the airway blocked by tumor, and in reducing tumor mass prior to definitive therapy. It provides a simple method of excision for curative therapy. All of this is accomplished with minimal morbidity. Most patients can return home on the first postoperative day. They can eat, have a serviceable voice, and require no tracheotomy or analgesics, all of which provide a significant cost benefit.

Bronchoscopy↗
PubMed1980

Work-up, evaluation, and treatment planning in patients with head and neck cancer.

The patient with head and neck cancer requires the recording of a full history and physical examination and a complete evaluation of the local disease; the local findings are viewed against the general medical background. In order to arrive at the optimal treatment, the findings should be reviewed fully at an interdisciplinary conference. In the light of these discussions the responsible team should develop a treatment plan, in concert with the patient and his family whenever possible. The treatment selected should offer the patient the best opportunity for cure, expose him to the last morbidity and expense, and leave him with the most options in the event of a failure. In the early stages of the disease the tendency to overtreat must be avoided.

Anesthesia, General↗
PubMed1980

Fine needle aspiration biopsy diagnosis of neck masses.

The cytologic findings in 107 aspiration smears obtained with the fine needle technique from head and neck masses were compared with the histologic findings in permanent sections. The overall concurrence rate between cytologic and histologic findings in benign and malignant tumors was 82.2 per cent. There was a 5.6 per cent incidence of false negative findings. There were no false positive results. Fine needle aspiration was found to be safe, complication free, and most helpful in planning treatment. We recommend the technique to others who deal with head and neck masses.

Biopsy, Needle↗
PubMed1980

Treatment of T1 and in situ glottic carcinoma: the transoral approach.

Endoscopic treatment of early carcinoma of the larynx is curative, the cure rates in our experience being equal to those achieved by radiation therapy and by laryngofissure. It is highly cost effective in terms of money and of patient out-of-work time. It can be used repeatedly and does not interfere with future treatments. It is our method of choice.

Carcinoma in Situ↗